The disease has different origins depending on whether it affects children or adults
Caused by an infection, osteomyelitis is inflammation of a bone and its marrow cavity. It is often caused by gods bacteriain particular Streptococci and Staphylococci, while the cases in which the disease originates from germs of another kind are extremely rare.
OSTEOMYELITIS: CAN BE ACUTE OR CHRONIC
—
Especially in adults osteomyelitis is often the consequence of a nearby infection and tends to appear after a very violent trauma or after the implantation of a prosthesis. This form of the disease is especially prone to those who have had exposed fractures, a situation in which harmful bacteria and germs can contaminate by direct contact. On the other hand, the form of osteomyelitis is rarer it depends on a traffic problem in peripheral areas of the body; in these cases, the most common cause is diabetic foot. “It’s typical of childhood and adolescence there ematogenic form of the disease. To determine its appearance are bacteria responsible for other pathologies, including cystitis, pharyngitis and otitis, which reach certain bones through the bloodstream. The most at risk are those supplied by many blood vessels, such as the femur, tibia, fibula, humerus, radius and ulna”, explains the Doctor Antonio Pellegrini, head of the Operative Unit of Reconstructive Surgery and Osteoarticular Infections of the Irccs Galeazzi-Sant’Ambrogio Hospital in Milan. Osteomyelitis can also be classified according to the duration: if they last less than a month they are considered acute, if they afflict for longer they are chronic.
OSTEOMYELITIS: TESTS FOR DIAGNOSIS
—
Osteomyelitis causes a ache occurring in the area of infection. This pain can also be so intense as to compromise the functionality of the affected part of the body. If pain is the characteristic symptom of the disease, others can be associated with it, such as swelling and fever. It is important not to neglect osteomyelitis, because otherwise there is a risk that the infection will spread, multiplying the discomfort and, in the worst cases, requiring surgery to remove the entire bone segment. If the doctor suspects the presence of this disease, he should first prescribe medications blood tests to observe the blood count with formula (white blood cells and leukocyte formula), the C-reactive protein, which if high indicates an ongoing infection, and the ESR (erythrocyte sedimentation rate, another indicator of inflammation). If these parameters are higher than normal, it means that there is inflammation, i.e. inflammation of the body. Subsequently, a radiological investigation is necessary, such as the MRI or, alternatively, an X-ray or a CT scan, tests that are also useful for locating the infection. “Finally, to understand which germ has triggered the infection, a cultural examinationwhich consists in taking a small part of the infected tissue” says Dr. Pellegrini.
TREATMENTS FOR OSTEOMYELITIS
—
When acute osteomyelitis is diagnosed, the first treatment that is resorted to is based on a specific antibiotic for the bacterium that caused the infection. It is rather rare that surgery is necessary to evacuate a possible abscess. In these cases, the cure with the antibiotic, which can be injected into a vein, intramuscularly, or taken orallyshould also be continued after the operation. In the chronic forms of this disease, “seizures”, i.e. dead bone fragments, often form. Since these parts of the bone are not supplied with blood, they cannot be reached by antibiotics either; therefore, in these areas the bacteria responsible for the infection can proliferate freely. In the presence of seizures, surgery is indispensable: one resorts, in fact, to one sequestrectomia, which consists in the removal of dead bone fragments and the cleaning of the bone. “Surgery is essential even if the disease compromises the bone throughout its thickness. In such circumstances, very complex techniques are required. Sometimes, with the help of circular external fixators, it is possible to lengthen the shortened bone to bring it back to its original length. Other times, it is rebuilt using autologous grafts (vascularized fibula). Finally, there is the Masquelet technique, which is divided into two stages” concludes Dr. Pellegrini.
© breaking latest news