Blood tests may reveal elevated levels of white blood cells and other factors that may indicate that your body is fighting an infection. If osteomyelitis is caused by an infection in the blood, tests may reveal which germs are to blame.
However, damage may not be visible until osteomyelitis has been present for several weeks. More-detailed imaging tests may be necessary if your osteomyelitis has developed more recently.
An open biopsy requires anesthesia and surgery to access the bone. In some situations, a surgeon inserts a long needle through your skin and into your bone to take a biopsy.
This procedure requires local anesthetics to numb the area where the needle is inserted. The most common treatments for osteomyelitis are surgery to remove portions of bone that are infected or dead, followed by intravenous antibiotics given in the hospital.
Depending on the severity of the infection, osteomyelitis surgery may include one or more of the following procedures: In a procedure called debridement, the surgeon removes as much of the diseased bone as possible and takes a small margin of healthy bone to ensure that all the infected areas have been removed.
Surrounding tissue that shows signs of infection also may be removed. Your surgeon may fill any empty space left by the debridement procedure with a piece of bone or other tissue, such as skin or muscle, from another part of your body.
The graft helps your body repair damaged blood vessels and form new bone. In some cases, foreign objects, such as surgical plates or screws placed during a previous surgery, may have to be removed.
As a last resort, surgeons may amputate the affected limb to stop the infection from spreading further. A bone biopsy will reveal what type of germ is causing your infection, so your doctor can choose an antibiotic that works well against that type of infection.
The antibiotics are usually administered through a vein in your arm for about six weeks. An additional course of oral antibiotics may be needed for more-serious infections.
It's also important to take steps to manage any chronic conditions you may have, such as keeping your blood sugar controlled if you have diabetes. While you might first discuss your signs and symptoms with your family doctor, you may be referred to a doctor specializing in infectious diseases or to an orthopedic surgeon.
Here's some information to help you get ready for your appointment, and what to expect from your doctor. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment. Make a list of all medications, vitamins or supplements that you're taking.
Are there any brochures or other printed material that I can take home with me? Refers HM, et al. Trends in the epidemiology of osteomyelitis : A population-based study, 1969 to 2009.
Alan T. Osteomyelitis in adults: Clinical manifestations and diagnosis. Seaman FD, et al. ACR Appropriateness Criteria suspected osteomyelitis, septic arthritis, or soft tissue infection (excluding spine and diabetic foot).
To diagnose osteomyelitis, the doctor will first perform a history, review of systems, and a complete physical examination. In doing so, the physician will look for signs or symptoms of soft tissue and bone tenderness and possibly swelling and redness.
The abnormalities can include a focal decrease in density, which can suggest bone destruction from bacteria. Blood tests: When testing the blood, measurements are taken to confirm an infection: a CBC (complete blood count), which will show if there is an increased white blood cell count; an ESR (erythrocyte sedimentation rate); and/or CRP (C-reactive protein) in the bloodstream, which detects and measures inflammation in the body.
A sample of blood is taken and then placed into an environment that will support the growth of bacteria. By allowing the bacteria to grow, the infectious agent can then be identified and tested against different antibiotics in hopes of finding the most effective treatment.
It is then sent to the lab to be evaluated by allowing the infectious agent to grow on media. Bone scan: During this test, a small amount of Technetium-99 pyrophosphate, a radioactive material, is injected intravenously into the body.
If the bone tissue is healthy, the material will spread in a uniform fashion. However, a tumor or infection in the bone will absorb the material and show an increased concentration of the radioactive material, which can be seen with a special camera that produces the images on a computer screen.
Last reviewed by a Cleveland Clinic medical professional on 11/28/2017. In: McKean SC, Ross JJ, Dressler DD, Roman DJ, Ginsberg JS.
Because the patient, a diabetic, is neuropathic, she isn’t sure how long she has had the ulcer, and test results and lab values don’t provide a lot of information. The patient’s sedimentation rate is just above 100, and her white blood cell count is slightly elevated.
Practice guidelines released last fall by the Infectious Diseases Society of America (IDEA), for example, note that osteomyelitis is the most “difficult and controversial aspect in the management of diabetic foot infections.” While this may seem like obvious advice, experts say that too many physicians ignore their diabetic patients’ feet.
But checking hospitalized patients for decubitus ulcers is an important step in detecting osteomyelitis before it produces serious damage. Lakshmi K. Halasyamani, MD, a hospitalist and associate chair of the department of medicine at St. Joseph Mercy Hospital in Ann Arbor, Mich., says that in a busy inpatient setting, the simple act of inspection often falls by the wayside.
“I can ’t tell you the number of patients who come up to the floor and no one has taken their shoes or socks off to look at their feet or lifted their gown,” says Dr. Halasyamani, who will talk about skin and soft tissue infections at the upcoming Fall 2005 Hospitalist CME Series. Gunner Deer, MD, an infectious disease specialist who co-authored the IDEA guidelines, says that time is often of the essence in catching foot infections.
Dr. Deer says that if the ulcer has been present for more than six weeks and hasn’t improved despite appropriate wound care and off-loading, suspect osteomyelitis. You probably know that if you can probe the bone in an infected foot ulcer, there is an 85 percent chance the patient has osteomyelitis.
And while MRI scans are expensive, Dr. Deer says the technology can provide a definitive diagnosis in difficult cases. And if you have a suspicious ulcer and can ’t probe the bone and the MRI is negative, he says, the patient probably doesn’t have osteomyelitis.
Most experts agree that when it comes to nailing down a diagnosis of osteomyelitis and establishing a course of antimicrobial therapy the gold standard is a bone biopsy. “We’re taking care of patients who have been exposed to multiple antibiotics in the past and have had other infections,” says Dr. Halasyamani, who thinks that bone biopsies are underused by hospitalists.
It also gives the surgeon a chance to debride infected tissue and bone, which will help the wound heal. In some instances, for example, concerns about damaging the structure of an already compromised foot may make a strong case against the procedure.
If the patient presents with a gangrenous foot, on the other hand, you’re probably looking at a poly microbial situation with gram negative organisms and anaerobes. Dr. Deer says that in these instances, you should probably lean toward broad coverage that will cover staff, strep, anaerobes and increasingly, MRSA.
“The duration of therapy for someone with osteomyelitis really depends on how much infected bone or soft tissue is left behind,” she says. Dr. Barbara, who authored a section on osteomyelitis for PIER, the American College of Physicians’ Web-based decision-support tool, says that if a surgeon has removed the infected bone, perhaps in a partial amputation, antibiotic therapy must be adjusted accordingly.
If the debridement is limited in trying to save as much limb as we can and osteomyelitic bone is left behind, then a four- to six-week course is appropriate.” Experts worry that too many physicians think they can cure osteomyelitis with antibiotics alone, a notion that has received a growing amount of attention.
Because there are questions about the methodology of those studies, however, most experts agree that osteomyelitis needs a multidisciplinary approach to be resolved. He urges physicians to view both oral and intravenous antibiotics as suppressive, not curative, therapy in most cases.
While the wound gradually heals, Dr. Snyder says, it can create a fistula from the bone to the skin. He notes that in one study, researchers found a 50 percent death rate one year after the diagnosis of an ulcer or osteomyelitis.