Bone infection, known as osteomyelitis, can lead to limb loss.  This is why it is important to make every effort to identify if bone infection is present when you have an infection that is not resolving.  Osteomyelitis, or osteo for short, can occur in any bone.  Those bones that are responsible for weight bearing are very important.  These include the spine, femurs, tibia and fibula, ankles and small bones of the feet.  Our office is most interested in limb salvage and cure of bone infections.

Diagnosis of bone infection (osteo) is made by several different measures. One is the use of a probe test.  If a wound is present and shows signs of infection, then any exposed bone in the bed of the wound is considered infected.  This is demonstrated by probing the wound to see if any bone can be exposed.  The probe test is one of the easiest ways to establish the diagnosis of osteomyelitis, or bone infection.  Alternative methods include, but are not limited to; CT scanning, MRI scanning, Bone Scans, WBC-tagged scans, and plain x-rays.  Which test is chosen usually depends on the duration of the infection and the site of the body involved. 

Treatment of osteomyelitis (bone infection) is best done with guidance from cultures taken from the involved bone.  This may require a minor procedure done by a radiologist or surgeon to obtain the culture if there is no exposed bone in a wound.  Care should be taken to choose antibiotics that penetrate bone well and are highly effective for the infecting agents.  Simply stated, the bugs (bacteria, fungi, or viruses) and the drugs (antibiotics) must match.  There are studies showing what is considered the "drug of choice" for each infecting organism and each site of the body.  When we choose the "drug of choice" for an infection, we have a much better chance of cure of the infection.  Antibiotics must be given in high enough doses and over a prolonged period of time in order to penetrate bone. 

Other issue of bone infection includes assuing good blood flow to the site of infection.  Antibiotics only go where blood flow goes as they travel via the bloodstream.   Additionally, any pressure at a site of infection should be given strong consideration.  Removal of pressure, including repsoitioning or non-weight bearing status is paramount for healing and cure.  This may mean that the infected patient use crutches for walking, a wheelchair for positioning, or frequent repositioning in bed or with paraplegic individuals.   

INFECTED PROSTHESES:

Foreign materials that are left in our bodies are called 'implantables'.  When a foreign body is implanted into our body, it becomes surrounded with our tissues.  Unfortunately, if our tissues become infected, then the foreign material may become seeded.  Since there is no blood flow into prostheses and foreign material, it becomes very difficult to erradicate infection.  Most of the time, the prosthesis or foreign body must be removed in order to clear infection.  After approximately 3 months  (the peak time of recurrence) has passed without major incident, replacement of any needed hardware can be done without undue risk.