Chronic Bone Infections (Osteomyelitis)

What is chronic osteomyelitis?

Chronic osteomyelitis is an established bone infection that has been present for a period of months or even years. It is often seen in individuals that have sustained open (contaminated) fractures, undergone multiple orthopedic procedures or had chronic wounds. Diabetes, poor circulation, extensive scaring, smoking, chronic edema and an impaired immune system are frequent contributing factors.

Could I have developed chronic osteomyelitis?

Draining wounds that fail to heal or intermittently reopen are suspicious for the presence of an underlying chronic bone infection. Additional signs and symptoms of osetomyelitis include local pain, redness, swelling and bony instability.

A series of lab and imaging tests are available to help your physician make a diagnosis. X-rays, MRI scan and a nuclear bone scan may be requested. Blood work may be draw to look for evidence of immune activity and inflammation (WBC, ESR, C-reactive protein).

The most accurate method of verifying the presence of chronic osteomyelitis is a bone biopsy.

How is chronic osteomyelitis treated?

Chronic osteomyelits is difficult to cure but can often be successfully controlled.

The cornerstones of treatment include complete excision of unhealthy bone, well-vascularized soft tissue coverage and administration of culture specific antibiotics.

Meticulous debridement (surgical removal) of all infected bone and scar tissue is essential in the treatment of chronic osteomyelitis. Multiple trips to the operating room are generally necessary to fully cleanse the wound prior to any reconstruction. Antibiotic beads are frequently left in the wound between cleanings where they release a high concentration of antibiotic locally.

Removal of unhealthy bone and scar often produce cavities that can fill with old blood or stagnant fluid. Plastic surgery techniques may be required to fill these spaces and cover the exposed bone with well-vascularized soft tissue. Local skin and muscle may be shifted (local flap) to fill the defect or muscle and tissue may be transferred from a distant location utilizing microsurgical techniques (free flap). The provision of undamaged healthy tissue into theses wounds enhances local circulation and delivers the oxygen, immune cells and antibiotics necessary to heal and fight infection.

During the period of wound preparation infected bone will be sent for microbiologic evaluation (culture). The offending organisms (bacteria, fungus, mycobacteria) are identified in the lab and the patient is typically started on a six-week course of culture specific antibiotics. Intravenous antibiotic therapy is often completed in the patient's own home with the assistance of a visiting nurse.

Chronic osteomyelitis is difficult to cure but with the assistance of a well-coordinated multidisciplinary team (Orthopedic Surgery, Plastic Surgery and Infectious Disease) long term control and a normal lifestyle can often be achieved.