Causes and risk factors
Osteomyelitis is caused by bacteria staphylococci, pseudomonas, and mycobacterium tuberculosis. Main source of infection is haematogenous spread although direct infection following a compound fracture, penetrating injury or orthopaedic surgery is possible. Infection of bone causes inflammation sometimes resulting in osteonecrosis. There may be formation of new bone by periosteum. Risk factors of the disease are age – childhood and adolescence, diabetes mellitus, compromised immunity and sickle cell disease. In old age Osteomyelitis can be caused in patients with peripheral vascular disease, prosthetic joint, gram negative bacilli.
Clinical presentation
Localised bone pain with tenderness, stiffness, accompanied by malaise, irritability and lethargy in children, night sweats and pyrexia. Pain and stiffness in the adjacent joint producing effusion or septic arthritis. In severe cases necrosis of the bone may occur. Pus formation in the cortex resulting in new bone formation with sinuses that discharge through the skin. In severe cases secondary amyloidosis and skin malignancy at the discharging sinus may occur.
Investigation
Medical history by the patient and Clinical examination by the orthopaedic doctor helps in diagnosis. X ray reveals local osteopenia adjacent to epiphysis, bone lucency and patchy sclerosis. X ray may be normal for first few weeks however bone technetium scans or white cell scans, MRI may reveal the disease condition. Confirmatory diagnosis is made by blood culture and infected bone tissue biopsy.
Treatment
Treatments involves pain relief with analgesics, antibiotics to combat infection. Surgery may be advised in case of necrosis. Resection of dead bone and reconstruction is required.
Other Modes of treatment
The other modes of treatment can also be effective in treating Osteomyelitis. Homoeopathy is a science which deals with individualization considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly the ayurvedic system of medicine which uses herbal medicines and synthetic derivates are also found to be effective in treating Osteomyelitis.
