Advanced Foot And Ankle Center Of San Diego

Experienced Medical and Surgical Care Of The Foot And Ankle

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What is Osteomyelitis

Osteomyelitis is an infection involving the bone caused by various microorganisms such as bacteria and fungi. These organisms can infect the bones in several ways:

  1. through the bloodstream from other infected areas of the body
  2. injury – bacteria enter the bone through a traumatic wound
  3. direct extension – spread to the bone from an adjacent wound or infection

Although the most common bacterial pathogens are species of Staphylococcus and Pseudomonas, it is important to identify the organism(s) responsible for each individual osteomyelitis infection. To do this, the infected tissues are sampled (biopsied) and incubated in the laboratory to grow as living cultures. The organisms are then identified according to their growth characteristics and appearance under the microscope. Once identified, they are tested for their sensitivity to various antibiotics.

The safest, most-efficient agent is chosen for delivery to the patient. Antibiotics are given by mouth (PO) as pills or liquids, by vein (IV) or by a direct application into the wound as a depot (antibiotic beads, gels, ointments, patches or suppositories).

In some instances, osteomyelitis can persist to become chronic due to the presence of injured tissue and foreign material within the wound.

Where Do These Organisms Come From?

Organisms gain access to the bone either by direct inoculation or are carried by the blood stream from some other site of infection. Traumatic inoculations (gunshot wounds, compound fractures, open surgery, etc.) account for a large percentage of the osteomyelitis cases seen at our center.

Classifications of Osteomyelitis

Osteomyelitis is classified according to what parts of the bone are involved in the disease (Types I – IV in figure below) and the health of the patient. Based on medical history, patients are classified as either compromised (B-Hosts) or uncompromised (A-Hosts). Compromised patients have decreased healing potential when compared to uncompromised patients. Conditions which may classify you as a compromised healer include:

  • Diabetes
  • Use of steroids
  • Poor nutrition
  • Extensive scarring
  • Use of tobacco products
  • Cancer
  • Previous radiation therapy
  • Organ failure
  • Chronic lymphedema
  • Old age

Tobacco use (smoking, in particular) is the most common compromising factor in patients treated for Osteomyelitis. With failures ranging from 30 to 100 percent in many protocols, the use of tobacco products during treatment may make the difference between limb salvage and amputation.

The classification (staging) of your bone infection is formulated by combining the type of disease with the host class (i.e., Stage IVB). As in the field of oncology, the clinical staging of osteomyelitis is used to direct therapy and predict a successful outcome. It also allows the comparison of patient cohorts to evaluate the effectiveness of various treatment methods.

If you need treatment for the bone infection osteomyelitis or any infection of the musculoskeletal system, our San Diego surgeons, who serve patients from Mexico and across the globe, can help you make the right decision. We want to give you the greatest potential for complete and successful healing. If you are interested in an Internet screening consultation.

Misunderstandings about Osteomyelitis

MYTH: The infection will continue to spread in the bone and eventually to the rest of my body.

FACT: Generally, osteomyelitis does not spread to other parts of your body because these other tissues are alive, have a blood supply, and are protected by your immune system. An exception to this is when there are artificial joints in other parts of your body. In these instances, the “foreign bodies” are vulnerable to circulating pathogens. In general, treatment of your bone infection is not an emergency. Your body’s protective mechanisms will usually keep the infection localized to the original site.

MYTH: The infection will make other people sick if they come into contact with me.

FACT: Your bone infection is usually not contagious and will not affect other people unless they are severely compromised. Good hand-washing practices (when you change dressings) and a clean dressing (over open wounds) should be enough to keep everyone protected.

MYTH: You or your doctor must have done something wrong for an infection to develop.

FACT: In most cases, no one is to blame. The type of injury or fracture may increase your chance of infection, as may your medical health. Some factors can be changed and thereby reduce your risk, but many can not. Tobacco use is the easiest to change.

MYTH: Antibiotics do not work in my body.

FACT: Antibiotics work so long as the organisms are vulnerable and the antibiotics are appropriately selected, administered, and regulated. However, antibiotics are usually not effective against organisms attached to dead bone and foreign-body surfaces (i.e., to wood, metal, plastic, etc.). The most efficient way to treat a chronic bone infection is to combine a thorough, surgical debridement with appropriate, antibiotic agents.

MYTH: Because my leg was once infected, I cannot have an operation to fix a bone deformity and restore function.

FACT: With proper staging and surgical planning, the success rate for a reconstruction at a previously infected site is 95 percent.

MYTH: The only way to cure chronic osteomyelitis is with an amputation.

FACT: This statement was true back in the 70s, but not today. It is very rare for amputation to be the treatment plan of choice for patients with chronic osteomyelitis.

The knowledge gained through years of treating patients has enabled me to anticipate many of your questions and fears. Our goal is to return you to a normal life, free from osteomyelitis and other types of infections. Although your extremity may never be the same as it was prior to injury, we will strive to return as much function and mobility as possible.

MYTH: My doctor tells me he has done everything that can be done and I will be wasting my time and money to try again.

FACT: Experience is everything when treating chronic osteomyelitis infections. The two-year success rate for 2,500 plus patients treated in our centers is over 94 percent. Yet, even with this vast experience, our techniques and methods continue to evolve.

There are several types of treatment for osteomyelitis and similar bone infections, including:

  • Free Tissue Transfers
  • Bone Grafts
  • Antibiotic Beads
  • External Fixators Ilizarov
  • Amputations
  • Hyperbaric Oxygen Therapy

Determining the Course of Treatment

During the treatment process, you will be expected to be an active partner. A surgical treatment plan and statistical chance for a cure will be discussed with you prior to beginning treatment. Treatment may be complex and plans may be altered along the way to ensure your safety and a good outcome. Our goal is to return as much function and. form to your extremity as possible. Prior to beginning treatment, it is imperative we know your complete medical history and you have listed your allergies and medical conditions; if compromising factors (co-morbidities) exist that can affect your outcome, many can be reversed prior to treatment to improve your treatment options and chance for cure – the selection of methods is based on specific host and wound parameters .

The basic treatment involves the following:

  • Debridement: All infected, and compromised tissues are surgically excised, including skin, muscle, tendon, ligaments, and bone. Foreign bodies and surgical implants are removed.
  • Rest: The tissues must rest and recover under the protection of good nutrition, antibiotics, and adequate blood flow.
  • Reconstruction: When the debrided would has healed, form and function can safely be restored using any and all orthopedic techniques.