What is osteomyelitis?
Osteomyelitis is an infection of the bone. Bones of our skeleton are living parts of our body.
They get their "food" supply from the blood.
- They grow.
- They heal when broken.
- They get infections like any other part of the body.
Bacteria, a type of germ, can settle into the bone and infect it. Bacteria get to the bone through the bloodstream or from surrounding tissue (such as from a cut or wound). It is usually unclear how bacteria get in the body and reach the bloodstream.
Children are at higher risk for osteomyelitis because their immune system is not fully developed. They also tend to have breaks in their skin allowing bacteria to get into the body. Because they are growing, children have a rich supply of blood to the growing parts of the bone allowing infections to spread quickly.
Osteomyelitis in children usually affects the long bones of the arms and legs. The two most common bacteria that cause bone infections in children are Staphylococcus aureus and group A Streptococcus.
Signs and symptoms of osteomyelitis
The signs and symptoms of osteomyelitis include:
- pain
- difficulty moving the affected area (for example limping)
- fever
- redness and swelling of the affected area
Diagnosis of osteomyelitis
If your child’s health-care team members suspect osteomyelitis, they will perform blood tests and imaging tests. Blood tests will include looking at markers of infection and inflammation, and looking for bacteria in the blood. Imaging tests may include:
- X-rays: These images, often normal early on, start showing signs of osteomyelitis after approximately two weeks of symptoms.
- An MRI: MRI looks more closely at the bones and soft tissues, and also helps your health-care team know whether or not there is a bone infection.
- A bone scan: This sensitive imaging test can show a bone infection about two weeks before it is visible on X rays.
Treatment of osteomyelitis
At the hospital
At the hospital, your child will receive antibiotics through one of their veins (intravenous) until they have improved. It usually takes a few days to about one week to get better. To assess how your child responds to treatment, the members of the health-care team will be monitoring your child’s:
- fever
- pain
- ability to use the affected limb
The team will also repeat some of the blood tests to see whether inflammation has decreased. A physiotherapist can also help with exercises for the affected limb.
Sometimes the joint can be infected as well. This is called septic arthritis. If there is a collection of infection, such as an abscess, your child may need to be seen by an orthopedic surgeon.
Once your child is ready to go home, the health-care team will give them an antibiotic to take by mouth. Your child will need to take this antibiotic for at least three to six weeks. In some cases, longer courses of intravenous antibiotics may be needed. The health-care team will discuss this with you if necessary.
At home
Upon discharge home from the hospital, let pain be the guide of your child’s activity level. You may continue to administer over the counter pain relievers such as ibuprofen or acetaminophen as needed. When there is infection present in the bone, the bone becomes more fragile and is more likely to break with accidental falls or injury. Your child should avoid contact sports and strenuous physical activity until a member of your health-care team says otherwise.
Your child will have a follow up visit with a member of their health-care team before the course of antibiotics is complete. At this visit, your child’s health-care provider will look for any signs of infection and will make sure your child has fully recovered and can return to all of their usual activities.
Your child should not have any long-term consequences if the condition is found early and fully treated.
When to see a doctor
Go see a doctor if:
- Symptoms return or worsen.
- Your child develops a fever.
- Redness and swelling appears at the affected area.
- Your child has difficulty moving the affected area.
- Your child does not tolerate the antibiotic.
If you live in Ontario and you are unsure about your child’s symptoms, you can call Health811 (811 | TTY: 1-866-797-0007).