c Definition

Osteomyelitis is an infection of the bone. It can be caused by a variety of microbial agents (most
common in staphylococcus aureus) and situations, including:

à în open injury to the bone, such as an open fracture with the bone ends piercing the skin.
à în infection from elsewhere in the body, such as pneumonia or a urinary tract infection that
has spread to the bone through the blood (bacteremia, sepsis).
à î minor trauma, which can lead to a blood clot around the bone and then a secondary
infection from seeding of bacteria.
à Jacteria in the bloodstream bacteremia (poor dentition), which is deposited in a focal
(localized) area of the bone. This bacterial site in the bone then grows, resulting in destruction
of the bone. However, new bone often forms around the site.
à î chronic open wound or soft tissue infection can eventually extend down to the bone
surface, leading to a secondary bone infection.

Osteomyelitis affects about two out of every 10,000 people. If left untreated, the infection can
become chronic and cause a loss of blood supply to the affected bone. When this happens, it can lead
to the eventual death of the bone tissue. Osteomyelitis can affect both adults and children. The
bacteria or fungus that can cause osteomyelitis, however, differs among age groups. In adults,
osteomyelitis often affects the vertebrae and the pelvis. In children, osteomyelitis usually affects the
adjacent ends of long bones. Long bones (bones of the limbs) are large, dense bones that provide
strength, structure, and mobility. They include the femur and tibia in the legs and the humerus and
radius in the arms. Osteomyelitis does not occur more commonly in a particular race or gender.
However, some people are more at risk for developing the disease, including:

à eople with diabetes

à atients receiving hemodialysis
à eople with weakened immune systems
à eople with sickle cell disease
à Intravenous drug abusers
à The elderly

c athophysiology

Osteomyelitis may be localized or it may spread through the periosteum, cortex, marrow, and
cancellous tissue. The bacterial pathogen varies on the basis of the patient's age and the mechanism
of infection.The following are the 2 primary categories of acute osteomyelitis: hematogenous
osteomyelitis and direct or contiguous inoculation osteomyelitis.Hematogenous osteomyelitis is an
infection caused by bacterial seeding from the blood. îcute hematogenous osteomyelitis is
characterized by an acute infection of the bone caused by the seeding of the bacteria within the bone
from a remote source. This condition primarily occurs in children. The most common site is the rapidly
growing and highly vascular metaphysis of growing bones. The apparent slowing or sludging of blood
flow as the vessels make sharp angles at the distal metaphysis predisposes the vessels to thrombosis
and the bone itself to localized necrosis and bacterial seeding.Vertebral osteomyelitis at any age is
most often a secondary complication of a remote infection with hematogenous seeding. In
approximately one half of vertebral osteomyelitis cases, a source can be identified such as urinary
tract or skin, and approximately one third may be diagnosed with endocarditis.1 îcute hematogenous
osteomyelitis, despite its name, may have a slow clinical development and insidious onset. Direct or
contiguous inoculation osteomyelitis is caused by direct contact of the tissue and bacteria during
trauma or surgery. Direct inoculation (contiguous-focus) osteomyelitis is an infection in the bone
secondary to the inoculation of organisms from direct trauma, spread from a contiguous focus of
infection, or sepsis after a surgical procedure. Clinical manifestations of direct inoculation
osteomyelitis are more localized than those of hematogenous osteomyelitis and tend to involve
multiple organisms. îdditional categories include chronic osteomyelitis and osteomyelitis secondary
to peripheral vascular disease. Chronic osteomyelitis persists or recurs, regardless of its initial cause
and/or mechanism and despite aggressive intervention. îlthough listed as an etiology, peripheral
vascular disease is actually a predisposing factor rather than a true cause of infection. Disease states
known to predispose patients to osteomyelitis include diabetes mellitus,2 sickle cell disease, acquired
immune deficiency syndrome (îIDS), intravenous (IV) drug abuse, alcoholism, chronic steroid use,
immunosuppression, and chronic joint disease. In addition, the presence of a prosthetic orthopedic
device is an independent risk factor, as is any recent orthopedic surgery or open fracture.