Osteomyelitis

Osteomyelitis is an infection of the bone, which can occur suddenly (acute) or develop as a long-standing, difficult-to-treat infection (chronic). It requires prompt diagnosis and prolonged antibiotic treatment, and sometimes surgery, to prevent permanent bone damage.

• Pain, swelling, warmth, and tenderness over the affected bone
• Fever, particularly with acute infection
• Reduced ability to use the affected limb, or reluctance to bear weight if a leg bone is involved, particularly in children
• In chronic osteomyelitis: a long-standing wound or sinus that intermittently discharges pus, sometimes with a history of a previous bone infection or injury

• Can result from bacteria reaching the bone through the bloodstream from an infection elsewhere in the body, particularly in children.
• Can also result from direct spread of infection from a nearby wound, open fracture, or surgical site, or from a deep wound that penetrates to the bone.
• Risk is increased by diabetes, poor circulation, weakened immunity, and open injuries involving bone.

• Suspected clinically based on localised bone pain, swelling, and fever, particularly in a child or someone with a relevant wound or recent infection.
• Blood tests often show signs of infection and inflammation.
• X-ray may not show changes early in the illness; further imaging, such as MRI or bone scan where available, can help confirm the diagnosis, particularly in early or uncertain cases.
• Bone or blood cultures help identify the causative organism and guide antibiotic choice.

Osteomyelitis requires a prolonged course of antibiotics, often starting intravenously in hospital and continuing for several weeks, sometimes transitioning to oral antibiotics as the infection improves.

Surgical debridement — removing infected or dead bone tissue — is often needed, particularly for chronic osteomyelitis or when there is a collection of pus, to allow antibiotics to work effectively and support healing.

Close monitoring is needed throughout treatment to assess response, given the risk of the infection persisting or recurring if not adequately treated.

Chronic osteomyelitis can be particularly difficult to fully cure and may require repeated courses of treatment and surgery over time.

• Ensure prompt and thorough treatment of any wound, particularly deep wounds or those involving bone.
• Manage underlying conditions such as diabetes well, as they increase infection risk and can impair healing.
• Seek prompt medical care for localised bone pain and fever, particularly in a child, as early treatment improves outcomes.
• Follow through with the full prescribed course of antibiotics, even once symptoms improve, given the risk of incomplete treatment leading to chronic infection.