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I. INTRODUCTION

Also called Myeloid Tissue Infection is an infection of the bone. It may occur by extension of soft
tissue infections, direct bone contamination (eg, bone surgery, gunshot wound), or hematogenous
(bloodborne) spread from other foci of infection.

Infections can reach a bone by traveling through the bloodstream or spreading from nearby tissue.
Possible complications include septic arthritis, subperiosteal abscess, pyomyositis, deep vein
thrombosis, sepsis, and multi-organ failure. Smokers and people with chronic health conditions, such
as diabetes or kidney failure, are more at risk of developing osteomyelitis. People who have diabetes
may develop osteomyelitis in their feet if they have foot ulcers.

Usually, bacteria causes infection in the bone. Staph aureaus is the most common organism in adults.
Leukocytes are attracted to the area and secrete enzymes in attempt to kill the bacteria.

Blood flow to the area is decreased and is a devitalized, necrotic bone is formed called a sequestrum.

Sequestrum – am infected, dead bone resulting from osteomyelitis.

II. Causes
a. Contiguous Spread
Contiguous spread from adjacent infected tissue or open wounds causes about 80% of
osteomyelitis; it is often polymicrobial. Staphylococcus aureus is present in ≥ 50% of patients;
other common bacteria include streptococci, gramnegative enteric organisms, and anaerobic
bacteria

Osteomyelitis that results from contiguous spread is common in the feet (in patients with
diabetes or peripheral vascular disease), at sites where bone was penetrated during trauma or
surgery, at sites damaged by radiation therapy, and in bones contiguous to pressure ulcers, such
as the hips and sacrum.

b. Hematogenous Spread
Hematogenously spread osteomyelitis usually results from a single organism. In children, gram-
positive bacteria are most common, usually affecting the metaphyses of the tibia, femur, or
humerus. In adults, hematogenously spread osteomyelitis usually affects the vertebrae.

Risk factors in adults are older age, debilitation, hemodialysis, sickle cell disease, and injection
drug use.

 In adults who are older, debilitated, or receiving hemodialysis: S. aureus (methicillin-resistant S.

aureus [MRSA] is common) and enteric gram-negative bacteria
 In injection drug users: S. aureus, Pseudomonas aeruginosa, and Serratia species
 In patients with sickle cell disease, liver disease, or immunocompromise: Salmonella species
Fungi and mycobacteria can cause hematogenous osteomyelitis, usually in immunocompromised
patients or in areas of endemic infection with histoplasmosis, blastomycosis, or coccidioidomycosis. The
vertebrae are often involved.

At risk for getting osteomyelitis if you have:

 Artificial joint, such as a hip replacement.

 Blood infection or conditions like sickle cell anemia.
 Diabetes, especially a diabetes-related foot ulcer.
 Metal implants in bone, such as a screw.
 Pressure injuries such as bedsores.
 Recent broken bone or bone surgery.
 Traumatic injury or wound.
 Weak immune system.

III. Classification of osteomyelitis acc to Duration:

1. Acute - <2 weeks
2. Subacute- 2-6 weeks
3. Chronic >6 weeks
 Persistent or relapsed infection
 Infection associated with prosthetic devices
 Histologic evidence of dead or necrotic cortical bone

IV. Signs and Symptoms

Signs and symptoms:

Fever
Swelling, warmth, and redness over the area of the infection
Pain in the area of the infection
Fatigue
Sometimes osteomyelitis causes no signs and symptoms or the signs and symptoms are hard to
distinguish from other problems. This may be especially true for infants, older adults, and people
whose immune systems are compromised.

Other signs of osteomyelitis include:

 Drainage (yellow pus).
 Fever.
 Irritability or lethargy.
 Limited, painful movement.
 Loss of appetite.
 Lower back pain.
 Nausea and vomiting.
 Sweating or chills.
Pathognomonic Sign
a. Acute
 Presence of intramedullary fat globules on T1-WI (“spine-lattice” relaxation time).
 Islands of fat are released by necrotic lipocytes (fat cells) resulting in high signal intensity
(SI) on T1-WI)
b. Chronic
 Presence of sequestra and/or sinus tracts is pathognomonic of chronic steomyelitis

V. Pathophysiology (Mine)

VI. Lab and Diagnostics tests (Mine)

 Blood Tests
o Complete Blood Count (CBC). - This test measures the size, number, and
maturity of blood cells. It’s done to check for increased white blood cells that
may signal an infection.
o Blood Cultures - This blood test looks for bacteria or other germs in the blood.
o Erythrocyte sedimentation rate (ESR) - This test measures how quickly red
blood cells fall to the bottom of a test tube. When swelling and inflammation are
present, the blood’s proteins clump together and become heavier than normal.
They fall and settle faster at the bottom of the test tube. The faster the blood
cells fall, the more severe the inflammation.
o C- reactive protein - This blood test helps find inflammation or an infection.
 Imaging Test
o X-ray - X-rays can reveal damage to your bone. 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.
o Magnetic Resonance Imaging - Using radio waves and a strong magnetic field,
MRI scans can produce exceptionally detailed images of bones and the soft
tissues that surround them.
o Computerized Tomography Scan (CT) - A CT scan combines X-ray images taken
from many different angles, creating detailed cross-sectional views of a person's
internal structures. CT scans are usually done only if someone can't have an MRI.
o Radionuclide bone scan - Pictures or X-rays are taken of the bone after a dye is
injected and absorbed by the bone tissue. These are used to find tumors,
infections, and bone abnormalities.
 Bone Biopsy/ Needle aspiration
o A small needle is inserted into the affected area to take a tissue biopsy.
o A bone biopsy can reveal what type of germ has infected your bone. Knowing
the type of germ allows your doctor to choose an antibiotic that works
particularly well for that type of infection.
 o 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. X-ray or other imaging scans may be used for
guidance.
 Acute osteomyelitis: Early x-ray films show only soft tissue swelling
 Chronic osteomyelitis: x-ray show large, irregular cavities, a raised periosteum, sequestra, or
dense bone formations
 Radioisotope bone scans and magnetic resonance imaging
 Blood studies and blood cultures
 GOLD STANDARD: bone biopsy with hispathologic examination and tissue culture

VII. Med Surg (Mine)

A. Medical management (Mine)

B. Surgical management
 Debridement
o Doctors may recommend a procedure called debridement to remove dead or
damaged bone tissue in people with osteomyelitis. During this procedure, the
doctor cuts away dead or damaged bone tissue and washes the wound to
remove any dead or loose tissue.
 Bone Grafts
o If bone has been removed to treat an infection, it may need to be replaced later.
Doctors may eventually replace the removed bone with a graft, a small piece of
bone taken from your hip or from a bone bank, a facility that stores donated
bone tissue. During this procedure, the doctor may implant antibiotics directly
into the bone.
 Skin and Muscle Grafts
o A skin graft may also be needed if the skin around the bone is infected and has
failed to heal. Skin grafts applied to the arms and legs can now often be done
using local or regional anesthesia.
o Sometimes the surgeon also moves some muscle to cover an area around a
bone infection. This can promote healing, because the muscle provides healthy
blood flow to the bone. Surgeons can often perform skin and muscle grafts at
the same time as debridement.
 o It can be difficult to completely eliminate osteomyelitis, which can become a
chronic infection. Multiple surgeries may be needed to completely remove the
damaged or dead bone.
VIII. Nursing management

 Promote bed rest

 Assess nutritional needs
 Administer antibiotics as ordered
 Administer pain medications as ordered
 Monitor and dress the wound as ordered
 Encourage out of bed activity
 Provide deep venous thrombosis and pressure sore prophylaxis
 Educate the patient about medication compliance
 Improve muscle strength and functioning
 Provide techniques to improve self-care
 Ensure the wound care nurse is following the patient

IX. References

https://www.cedars-sinai.org/health-library/diseases-and-conditions/o/osteomyelitis.html

https://nyulangone.org/conditions/osteomyelitis/treatments/surgery-for-osteomyelitis

Professional, C. C. M. (n.d.). Osteomyelitis. Cleveland Clinic.

https://my.clevelandclinic.org/health/diseases/9495-osteomyelitis

Momodu, I. I. (2023, May 31). Osteomyelitis (Nursing). StatPearls - NCBI Bookshelf.

https://www.ncbi.nlm.nih.gov/books/NBK568766/

https://medizzy.com/feed/89442

https://www.researchgate.net/figure/Case-1-was-a-34-year-old-female-The-patient-had-osteomyelitis-
of-her-carpal-bone-and-a_fig1_346609891

Tu YK, Yen CY. Role of vascularized bone grafts in lower extremity osteomyelitis. Orthop Clin
North Am. 2007 Jan;38(1):37-49, vi. doi: 10.1016/j.ocl.2006.10.005. PMID: 17145293.