Osteomyelitis – Cause, Symptoms & Treatment

What is Osteomyelitis?

Osteomyelitis is an infection and inflammation of the bone or the bone marrow. It can happen if a bacterial or fungal infection enters the bone tissue from the bloodstream, due to injury or surgery. Around 80 percent of cases develop because of an open wound. Symptoms include deep pain and muscle spasms in the inflammation area, and fever.Bone infections commonly affect the long bones in the leg and upper arm, the spine, and the pelvis. In the past, it was difficult to treat osteomyelitis, but now, aggressive treatment can often save the infected bone and stem the spread of infection.


Osteomyelitis can occur when a bacterial or fungal infection develops within a bone or reaches the bone from another part of the body. When an infection develops inside the bone, the immune system will try to kill it. Neutrophils, a type of white blood cell, will be sent to the source of the infection to kill the bacteria or fungus. If the infection takes hold and is not treated, dead neutrophils will accumulate inside the bone, forming an abscess, or pocket of pus.

The abscess may block vital blood supplies to the affected bone. In chronic osteomyelitis, the bone may eventually die. Bones are normally resistant to infection, but infection may enter a bone under certain conditions.

An infection in the bloodstream, complications of trauma or surgery, or pre-existing conditions, such as diabetes, reduce the person’s ability to resist infection.


Successful treatment of the infection is normally possible, but sometimes complications occur. Chronic osteomyelitis can appear to have gone, but then it resurfaces, or it may persist undetected for years. This can lead to bone tissue death and the collapse of the bone.

People with conditions that are difficult to treat, such as severe diabetes, HIV, poor circulation, or a weakened immune system are more at risk.

Signs and symptoms

The signs and symptoms of osteomyelitis depend on the type.

They commonly include:

  • Pain, which can be severe, and swelling, redness, and tenderness in the affected area
  • Irritability, lethargy, or fatigue
  • Fever, chills, and sweating
  • Drainage from an open wound near the infection site or through the skin

Other symptoms may include swelling of the ankles, feet, and legs, and changes in walking pattern, for example, a limp.

The symptoms of chronic osteomyelitis are not always not obvious, or they could resemble the symptoms of an injury.

This can make accurate diagnosis more difficult, especially in the hip, pelvis, or spine.

Osteomyelitis in children and adults

In children, osteomyelitis tends to be acute, and it usually appears within 2weeks of a pre-existing blood infection. Diagnosis can be difficult, but it is important to get a diagnosis as soon as possible, because delaying diagnosis can lead to growth disturbances or deformity. It can be fatal.

In adults, sub-acute or chronic osteomyelitis are more common, especially after an injury or trauma, such as a fractured bone. This is known as contiguous osteomyelitis. It usually affects adults over the age of 50 years.


Treatment depends on the type of osteomyelitis.

Acute osteomyelitis

In acute osteomyelitis, infection develops within 2 weeks of an injury, initial infection, or the start of an underlying disease. The pain can be intense, and the condition can be life-threatening.

A course of antibiotics or antifungal medicine is normally effective. For adults, this is usually a 4- to 6-week course of intravenous, or sometimes oral, antibiotics or antifungals. Some patients need treatment in hospital, while others may receive injections as an outpatient, or at home if they can inject themselves.

Possible side effects from antibiotics include diarrhea, vomiting, and nausea. Sometimes there may be an allergic reaction.

If the infection is caused by MRSA or some other drug-resistant bacteria, the patient may need a longer course of treatment and a combination of different medications.

In some cases, hyperbaric oxygen therapy (HBOT)may be recommended.

Sub-acute osteomyelitis

In sub-acute osteomyelitis, infection develops within 1–2 months of an injury, initial infection, or the start of an underlying disease.

Treatment depends on severity, and whether there is any bone damage.

If there is no bone damage, treatment is similar to that used in acute osteomyelitis, but If there is bone damage, treatment will be similar to that used in chronic osteomyelitis .

Chronic osteomyelitis

In chronic osteomyelitis, infection starts at least 2 months after an injury, initial infection, or the start of an underlying disease.

Patients usually need both antibiotics and surgery to repair any bone damage.

Surgery can involve:

  • Draining: The area around the infected bone may need opening up for the surgeon to drain any pus or fluid that has built up in response to the infection.
  • Debridement: The surgeon removes as much diseased bone as possible, and takes a small margin of healthy bone to ensure that all the infected areas are removed. Any surrounding tissue with signs of infection may also need removing.
  • Restoring blood flow to the bone: Any empty space left by debridement may have to be filled with a piece of bone tissue, or skin or muscle from another part of the body. Temporary fillers can be used until the patient is healthy enough for a bone or tissue graft. The graft helps the body repair damaged blood vessels, and it will form new bone.
  • Removal of foreign objects: If necessary, foreign objects placed during previous surgery may be removed, such as surgical plates or screws.
  • Stabilizing the affected bone: Metal plates, rods, or screws may be inserted into the bone to stabilize the affected bone and the new graft. This may be done later. Occasionally external fixators are used to stabilize the affected bone.

If the patient cannot tolerate surgery, for example, because of illness, the doctor may use antibiotics for longer, possibly years, to suppress the infection.

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