Osteomyelitis Surgery

Osteomyelitis is a bacterial, or fungal, infection of the bone that can affect both adults and children and can lead to bone tissue death over time if left untreated.

Some facts about Osteomyelitis:

• Osteomyelitis can become chronic and cause a loss of blood supply to the affected bone and eventual death of the bone tissue if left untreated.
• Osteomyelitis affects the vertebrae and the pelvis in case of adults where as the adjacent ends of long bones get affected in case of children.
• Long bones are present in the arms or legs o your body which are large, dense bones and provide strength, structure as well as mobility.
• People with diabetes or with weakened immune systems, patients receiving hemodialysis, people with sickle cell disease, intravenous drug abusers and the elderly are more prone for developing the disease.
• Osteomyelitis is caused by a bacteria called Staphylococcus aureus in most of the cases. However, it can be caused by a variety of microbial agents and situations.
• When an open injury to the bone, such as an open fracture with the bone ends coming out through the skin, it can cause osteomyelitis.
• A blood clot around the bone because of a minor trauma can lead to a secondary infection from seeding of bacteria.
• Germs in other parts of your body such as in the bladder from a urinary tract infection or in the lungs from pneumonia can travel through your bloodstream to a weakened spot in a bone to cause osteomyelitis.
• A direct bone infection can occur when a chronic open wound or soft tissue infection will extend down to the bone surface.
• Pain and/or tenderness in the infected area, swelling, redness and warmth in the infected area, fever, nausea, secondarily from being ill with infection, general discomfort, uneasiness, or ill feeling and drainage of pus through the skin are some of the common symptoms of osteomyelitis.

Risk of Osteomyelitis:  

• Your risk of an infection can be increased leading to osteomyelitis when you require a medical tubing such as dialysis machine tubing, urinary catheters or long-term intravenous tubing, sometimes called central lines.
• You have a greater risk of osteomyelitis if your immune system is affected by a medical condition or medication such as cancer treatment, poorly controlled diabetes or taking medication such as corticosteroids or tumor necrosis factor inhibitors.
• People are more likely to develop osteomyelitis who inject illegal drugs as they may use nonsterile needles and are less likely to sterilize their skin before injections.
• The infection fighting cells that are needed to keep a small infection from growing larger can not be distributed properly in your body when blood vessels are damaged or blocked leading to circulation disorders. In such cases, a small cut can lead to a deep ulcer that may expose deep tissue and bone to infection.
• Poorly controlled diabetes, peripheral artery disease and sickle cell disease are some of the diseases that impair blood circulation which can lead to osteomyelitis.
• Bacteria can enter your bone or nearby tissue through a severe bone fracture or a deep puncture wound.
• Germs can also enter a bone when a surgery is done to repair broken bones or replace worn joints.

Preparation for Osteomyelitis Surgery:

• Several test will be conducted to determine which germ is causing the infection before doing an Osteomyelitis Surgery.
• Elevated levels of white blood cells and other factors will be determined by blood test.
• X-rays can reveal damage to your bone if osteomyelitis has been present for several weeks.
• Exceptionally detailed images of bones and the soft tissues that surround them can be produced by MRI test.
• A CT scans can be done only if someone can't have an MRI which will create detailed cross-sectional views of the internal structures of a person by combining X-ray images taken from many different angles.
• A bone biopsy can be done to determine the type of germ that has infected your bone which allows your doctor to choose an antibiotic that works particularly well for that type of infection.

Procedure for Osteomyelitis Surgery:

• Anesthesia and surgery is required to access the bone in an open biopsy.
• A long needle will be inserted through your skin and into your bone by the surgeon to take a biopsy in some cases. Local anesthetics is required to numb the area where the needle is inserted in this procedure. X-ray or other imaging scans can be used for guidance.
• Surgery is the most common treatments for osteomyelitis to remove portions of bone that are infected or dead, followed by intravenous antibiotics given in the hospital.
• Osteomyelitis surgery may require one or more procedures depending on the severity of the infection.
• Any pus or fluid that has accumulated because of the infection will be drained by the surgeon by opening up the area around your infected bone.
• As much of the diseased bone as possible along with the surrounding tissue that shows signs of infection will be removed by the surgeon in the process of debridement. A small margin of healthy bone will also be removed to ensure that all the infected areas have been removed.
• Any empty space left by the debridement procedure will be filled with a piece of bone or other tissue, such as skin or muscle, from another part of your body.
• Temporary fillers are sometimes placed in the pocket until you are healthy enough to undergo a bone graft or tissue graft which will help your body repair damaged blood vessels and form new bone.
• Foreign objects, such as surgical plates or screws placed during a previous surgery, may have to be removed in some cases.
• The affected limb may be amputated to stop the infection from spreading further in some cases.
• Surgery is not performed unless there is compression of the spinal cord or nerve roots in the case of spinal abscesses

Recovery from Osteomyelitis Surgery:

• The surgery will be followed by some antibiotics which are usually administered through a vein in your arm for about six weeks.
• Antibiotics against the specific bacteria involved in the infection will be intensively administered during the hospital stay and for many weeks afterward after the surgery.
• An additional course of oral antibiotics may be required for more serious infections.
• Quitting smoking can help speed healing if you smoke.
• Any chronic conditions you may have should be managed in order to recovery fast.