What are the other Names for this Condition? (Also known as/Synonyms)

• Chronic Bone Infection

What is Chronic Osteomyelitis? (Definition/Background Information)

• Osteomyelitis indicates an inflammation of the bone due to a variety of reasons including infections. In case of infections, the condition is commonly caused by a bacteria or fungus.
• Osteomyelitis is classified into acute, subacute, and chronic forms.
• Chronic Osteomyelitis is a severe, persistent, incapacitating infection of bone, which develops after two months of an injury or initial infection.
• It is most commonly seen in adults and is usually caused by an injury or trauma such as a fractured bone.
• The common signs and symptoms of Chronic Osteomyelitis are pain and movement restriction of the affected bone.
• Treatments for Chronic Osteomyelitis include antibiotics and surgery to remove the dead tissue. In most cases, the condition can be effectively treated and controlled.

Who gets Chronic Osteomyelitis? (Age and Sex Distribution)

• Chronic Osteomyelitis affects both children and adults, but it is more common in adults
• This condition affects males more than females
• The condition is seen worldwide; no race or ethnicity is particularly preferred

What are the Risk Factors for Chronic Osteomyelitis? (Predisposing Factors)

The risk factors associated with Chronic Osteomyelitis include:

• Gender: Males are more affected than females
• Age: Adults are at a high risk of contracting Chronic Osteomyelitis
• Infections: Individuals, who are constantly prone to infections, are more susceptible to Chronic Osteomyelitis
• Intravenous drug abusers: Those who use intravenous drugs have a weak immune system and hence, carry a higher risk of Chronic Osteomyelitis
• Patients on dialysis get infections easily and hence, have a high risk
• Patients with urinary catheters are more likely to be affected by Chronic Osteomyelitis
• Individuals with poor or weakened immune system
• Individuals with chronic diseases, such as diabetes, peripheral arterial disease, and sickle cell disease
• Injuries: A deep, punctured wound or a broken bone can lead to the onset of osteomyelitis
• Bone surgery: Surgery to repair bones or replace joints carries a high risk of susceptibility to the condition

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Chronic Osteomyelitis? (Etiology)

A bacterial or fungal infection can develop within the bone from direct inoculation, or reach the bone from another part of the body. When an infection develops inside the bone, the body’s immune system will try to destroy it by using neutrophils, which are a type of white blood cell. If the infection remains in the body and is left untreated, the dead neutrophils get accumulated inside the bone, forming an abscess. The abscess will block the flow of blood to the affected area. This results in osteomyelitis.

The possible causes for Chronic Osteomyelitis may be:

• Inadequate treatment of acute osteomyelitis
• Spread of infection from another organ via blood to the bone
• Trauma
• Iatrogenic causes: Caused indirectly from joint replacements and internal fixation of fractures
• Compound fractures
• Infection with organisms such as Mycobacterium tuberculosis and Treponema species
• Contiguous spread from soft tissues

What are the Signs and Symptoms of Chronic Osteomyelitis?

The signs and symptoms of Chronic Osteomyelitis could include:

• Pain and tenderness in the affected area of the bone
• Affected area may look strange or deformed, instability
• Chronic fatigue
• Redness in the affected area
• Possibility of a drainage from an open wound near the area of infection
• Loss of movement in the affected area or limb
• Irritability

How is Chronic Osteomyelitis Diagnosed?

The diagnostic procedure for Chronic Osteomyelitis will include a complete evaluation of medical history along with a thorough physical exam. During the physical exam, the physician will look for:

• Range of motion of the involved bone and the surrounding joints
• Involvement of the adjacent structures like skin and soft tissue

Some of the diagnostic tests used may include:

• Radiologic assessment such as x-ray, MRI scan, and bone scan
  • To evaluate bone involvement
  • To identify soft tissue involvement
• Ultrasonography may provide information on soft tissue involvement

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Chronic Osteomyelitis?

The complications of Chronic Osteomyelitis may include:

• Risk of recurrence: Patients, who have already had an episode of Chronic Osteomyelitis, are at an increased risk of infection recurrence
• Amputation: When the condition becomes severe and it is not possible to be treated with conservative measures, then amputation of the limb (foot or arm) may be required

How is Chronic Osteomyelitis Treated?

Chronic Osteomyelitis treatment usually involves the use of both antibiotics and surgery. The surgical process includes:

• Draining the infected area: The area around the infection is opened up, to clean the pus and fluid accumulated
• Debridement: Removal of all the diseased bone
• Restoring blood flow to the bone: A bone or tissue graft is performed, whereby the bone tissue, muscle, or skin from other parts of the body is taken and placed to fill the space created by the debridement procedure
• Stabilizing the affected bones: Metal plates, screws, and rods may be inserted to stabilize the bone and the new graft
• If the patient’s health condition does not permit a surgery, then antibiotics are continued for a longer period of time

How can Chronic Osteomyelitis be Prevented?

Preventive measures for Chronic Osteomyelitis may include:

• Taking utmost precautions to avoid cuts and scrapes, if you are vulnerable to infections
• When you have a cut, clean it thoroughly and place a bandage over it
• Check the wounds regularly to ascertain if an infection has developed
• Urgently consult your physician if you have a non-healing and long-standing infection of the skin

What is the Prognosis of Chronic Osteomyelitis? (Outcomes/Resolutions)

In most cases, Chronic Osteomyelitis can be treated and controlled effectively.

Additional and Relevant Useful Information for Chronic Osteomyelitis:

Acute Osteomyelitis is a condition that develops within two weeks of an injury or initial infection. It is most commonly seen in children.