Osteomyelitis

Osteomyelitis is the medical term for inflammation in a bone. It's usually caused by a bacterial infection. It often affects the long bones of the arms and legs, but can happen in any bone.

Osteomyelitis is most often caused by bacteria (in some cases, it can also be caused by a fungal infection), which can infect bones in a few ways. For instance:

• Bacteria can travel into the bone through the bloodstream from other infected areas in the body. This is called hematogenous (heh-meh-TAH-gen-us) osteomyelitis. It's the most common way that kids get bone infections.
• A direct infection can happen when bacteria enter a wound and travel to the bone (like after an injury or surgery). Open fractures — breaks in the bone with the skin also open - are the injuries that most often develop osteomyelitis.
• Sometimes the bacteria can spread from a nearby infection. For example, an untreated infection in skin or a joint can spread to the bone.

Osteomyelitis is most common in young kids under age 5. But it can happen at any age. Boys get it almost twice as often as girls do.

Children and teens with diabetes or weakened immune systems may be more at risk for a bone infection.

Kids with osteomyelitis often feel pain in the infected bone. They also might:

• Have a fever and chills
• Feel tired or nauseated
• Generally not feel well
• Have sore, red, and swollen skin above the infected bone

Very young children might stop using the infected limb and protect it from being touched. They may also be fussy or eat less.

Older children and teens tend to get osteomyelitis after an accident or injury. The injured area may begin to hurt again after seeming to get better.

If your child has a fever and bone pain, visit the doctor right away. Osteomyelitis can get worse within hours or days and become much harder to treat.

The doctor will do a physical exam and ask questions about recent injuries to the painful area. Blood tests can check for an increased white blood cell count (a sign of infection) and other signs of possible inflammation or infection. An X-ray may be ordered although X-rays don't always show signs of infection in a bone in the early stages.

The doctor might suggest a bone scan to get a more detailed look at the bone. The doctor might also recommend an MRI, which gives much more detailed images than X-rays. MRIs not only can diagnose osteomyelitis, but can help establish how long the bone has been infected.

The doctor may do a needle aspiration to get a sample from the bone. This lets the doctor find out which bacteria caused the infection. It also can help the doctor decide which antibiotic would best treat the infection.

The treatment plan for your child's osteomyelitis depends on the following:

• The age and general health of the child
• How severe the infection is
• Whether the infection is acute (recent) or chronic (has been going on for a longer time)

Treatment includes antibiotics for the infection and medicine for pain relief. Most kids with osteomyelitis have a brief stay in the hospital to get IV (given in a vein) antibiotics to fight the infection. They can go home when they feel better, but might need to continue IV or oral antibiotics for several more weeks.

Sometimes surgery is needed to clean out an infected bone. If a cavity or hole developed in the bone and is filled with pus (a collection of bacteria and white blood cells), a doctor will do a debridement. In this procedure, the doctor cleans the wound, removes dead tissue, and drains pus out of the bone so that it can heal.

Most children with osteomyelitis feel better within a few days of starting treatment. IV antibiotics often are switched to oral form in 5 to 10 days. Kids usually get antibiotics for at least a month, and sometimes longer depending on symptoms and blood test results.

One way to prevent osteomyelitis is to keep skin clean. All cuts and wounds — especially deep wounds — should be cleaned well. Wash a wound with soap and water, holding it under running water for at least 5 minutes to flush it out.

To keep the wound clean afterward, cover it with sterile gauze or a clean cloth. You can apply an over-the-counter antibiotic cream, but the most important thing is to keep the area clean. Wounds should begin healing within 24 hours and completely heal within a week.

A wound that takes longer to heal or causes extreme pain should be checked by a doctor.

And, as with many infections, parents and kids should wash their hands well and often to stop the spread of germs. Kids also should have their vaccinations kept up to date.