The medical profession speaks of an inflammation of the bone (osteitis) when there is an infection, which – in very many cases – is provided with malignant microorganisms. Operations or even open fractures (breaks) increase the risk of bone inflammation. In very many cases, only radical surgery is the only treatment option when the patient is affected by osteitis.
What is osteitis?
Under an osteitis or bone inflammation, the medical profession describes a special infection that mainly affects the bone. In osteitis, the Havers or Volkmann canals can be affected. If the Havers’ canals are affected, the infection is in the longitudinal directions of the supply lines of the bone. Nerves and capillaries run through these channels. If the pathogen is present in the Volkmann’s canals, it is an infection in the transverse directions of the bone structures. However, in many cases osteitis occurs in combination with inflammation of the bone marrow. Due to the fact that osteitis and bone marrow inflammation (osteomyelitis) have similar clinical pictures, physicians often use the terms ostitis, osteitis as well as osteomyelitis as synonyms.
Causes
Osteitis occurs because of infection. Only rarely do foci of infection that have already flared up in the body spread to the bone. In most cases, osteitis develops in the setting of an open fracture. The pathogens enter via the open wound, infect the bone and trigger inflammation. Even surgery increases the risk of osteitis. For example, if germs – due to non-sterile instruments – get into the wound and directly onto the bone. Sometimes viruses and fungi can be the causative agents of bone inflammation; in almost all cases, however, bacteria are responsible for osteitis. Streptococci in particular play a significant role. Bacteria that occur in the course of a nosocomial infection can also trigger osteitis. These are mainly classic infections that occur in nursing homes and hospitals. Predominantly, these are multi-resistant germs, which cannot be fought by antibiotics. Sometimes the pathogens also include strains of Staphylococcus aureus; that strain is the main cause of osteitis.
Symptoms, complaints, and signs
Classic symptoms include redness as well as swelling of the affected area. The patient complains of bone pain, has an elevated body temperature or suffers from fever. In many cases, those affected are fatigued, report pain in the limbs and also in the joints, and – in the later course of the disease – bone fractures may also occur. If osteitis is not treated or is treated inadequately, pus may leak out.
Diagnosis and course of the disease
Osteitis is manifested by five classic symptoms of inflammation. Those occur together. These are redness, heat, pain, swelling and functional limitations. If open wounds or fistulas are present, pus formation can be observed. The physician already recognizes osteitis by the blood count. In blood tests, the physician not only detects a strong inflammatory reaction, but also a significantly elevated leukocyte count. Magnetic resonance imaging provides information on whether bone changes have already occurred. Sometimes necrotic processes may have occurred. This means that the bone substance is dying. If osteitis is present, only radical surgery can be successful. Although these are risky, they cannot be postponed or prevented. Depending on the extent of osteitis, permanent damage or disability may occur.
Complications
In most cases, osteitis results in very severe swelling of the affected region of the body. In this case, patients usually suffer from very severe pain after the bones break and also from restricted movement. It is possible that the affected person is then dependent on the help of other people in his or her everyday life. Osteitis also leads to a high fever and general fatigue in the patient. There is also a marked decrease in exercise tolerance and pain in the extremities and joints. The patient’s quality of life is generally significantly reduced by osteitis.Complications usually occur if treatment is not carried out. The inflammation can also spread to other areas of the body and possibly even penetrate to the outside. In the worst case, it can also lead to blood poisoning, which can be fatal for the affected person. Osteitis is usually treated by surgical intervention and with the help of antibiotics. As a rule, the course of the disease is positive without complications. Osteitis also does not usually affect the life expectancy of the affected person.
When should you go to the doctor?
A doctor should be consulted if bone or joint pain occurs. Osteitis is manifested by discomfort around the bones that rapidly becomes more severe and spreads as the disease progresses. If the above symptoms appear, the family doctor must be consulted. He can make a diagnosis on the basis of a scintigraphy and inform the patient about the next steps. People who already suffer from a disease of the bones are particularly at risk. Elderly people and patients with genetic predispositions such as malformations are also at increased risk of the disease. Similarly, people suffering from bone cancer or who are unable to move due to a pre-existing condition have an increased risk of complications and should see their GP immediately if they notice the bone pain or joint dysfunction described. Osteitis is treated as an inpatient in a specialized clinic. The patient should attend regular follow-up after surgery and, in addition, consult the physician if unusual symptoms occur.
Treatment and therapy
Due to the fact that osteitis is a bacterial infection, antibiotics must be prescribed. In many cases, oral medication is not sufficient; often, infusion medications are prescribed, but these also do not lead to the desired success. For this reason, the physician must – in almost all cases – operate and excise the affected area of the bone. In doing so, the physician concentrates on the inflamed or already necrotic part of the bone. If stabilizing measures in the form of screws or nails were placed as a result of fracture treatment, the physician must remove those instruments. However, the fracture site must still be fixed; new or different instruments are used for this purpose. Disinfecting rinses also take place during the operation. This is to remove the pathogens completely. Chains or tamponades soaked with antibiotics remain in the surgical wound afterwards. Furthermore, a drain is inserted so that the purulent secretions can be drained. The physician may sometimes leave the surgical wound open if there is a risk of having to perform another operation. This is because the operation does not always bring the desired success and healing of the osteitis. For this reason, a second operation may be necessary. Even if the healing process has already occurred and it is suspected that there are still foci of inflammation, a second operation may be performed. Due to the fact that the interventions have caused a loss of substance, this must be compensated again. Thus, the patient must work on restoring his mobility. In the absence of rehabilitation or inadequate rehabilitation, disability can sometimes affect mobility.
Outlook and prognosis
The prognosis of osteitis depends on a variety of factors. These include the age of the affected person, the type of inflammation, and what type of triggering bacteria is involved. Likewise, the strength of the immune system plays an important role. The outlook for osteitis is positive if acute osteomyelitis is present. Even in the case of bone inflammation, healing can be achieved in most cases without permanent impairments remaining. The basic prerequisite, however, is early diagnosis and appropriate expert treatment. The prognosis is less favorable in the case of chronic osteitis. Chronic osteitis primarily affects adult patients. In contrast, the healing prospects for children are considered to be more favorable. However, growth disorders must sometimes be expected in children if the growth plates are affected by the inflammation.In children, for example, the growth plates are still composed of cartilage. The cartilage permanently forms new bone substance for growth. However, if this process is disturbed, there is a risk of short stature. Depending on the location of the inflammatory focus, arms or legs may become shortened. It is not uncommon for the chronic course of osteitis to last for several years. In addition, recurrence is possible. A relapse can even occur years after treatment. Containing the inflammation by surgical intervention usually has a positive effect on the course.
Prevention
Osteitis can be prevented only to a limited extent by the affected person; rather, the hospital must take care – within the framework of hygiene – to prevent osteitis. If osteitis is suspected, a physician must be contacted immediately.
Follow-up care
In osteitis, the measures of follow-up care are usually significantly limited. For this reason, the affected person should see a doctor very early in this disease to avoid further complications or further discomfort in the affected person, which could negatively affect the patient’s quality of life. An early diagnosis usually always has a very positive effect on the further course of the disease. In most cases, osteitis disease requires a new surgical intervention. After this operation, the affected person should take it easy and rest, and bed rest should be observed. The wound should be particularly well protected to prevent further infection and other discomfort. Regular check-ups are also very important after the affected person has been discharged. As a rule, osteitis does not reduce the patient’s life expectancy if it is recognized and treated in time. Further measures of aftercare are usually not available to the affected person and are not necessary in this case. However, a high standard of hygiene should generally be observed.
What you can do yourself
Once the diagnosis of osteitis is confirmed, the affected patient should reliably take or have infused the prescribed medications (antibiotics) according to the doctor’s instructions. The physician may have to operate to prevent sepsis. Despite all therapeutic measures, further foci of inflammation may be active in the body. Therefore, it is advisable for the patient to take additional measures against the inflammations. Orthomolecular medicine recommends taking the mineral zinc and vitamins C and E for inflammation, while phytotherapists would advise herbal remedies such as echinacea, chamomile or linden blossoms. A naturopathic doctor can make specific recommendations here. If the inflamed areas are still swollen, they should be cooled. Cooling pads or so-called Coolpads, which are available in pharmacies, are suitable for this purpose. They should be stored in the freezer compartment of the refrigerator and, if necessary, wrapped with a towel and applied. Under no circumstances should the cooling pad be placed directly on the skin, as this can result in cold burns. It is important during this time to strengthen the patient’s immune system. This includes a healthy diet rich in vitamins and minerals as well as regular sleep. At the same time, the patient should refrain from indulgence toxins such as nicotine, coffee and alcohol. Daily exercise in the fresh air also supports the immune system.