bone inflammation

Bone inflammation: description

Bone inflammation is an inflammation of the bone substance. In everyday use, the term bone inflammation is used in general for the inflammation of the outer, hard bone substance as well as the bone marrow. However, physicians more specifically distinguish between inflammation of the hard substance of the bone (osteitis) without involvement of the bone marrow and inflammation of the bone marrow (osteomyelitis).

Osteitis and osteomyelitis are mostly caused by bacteria (very rarely by viruses or fungi) and occur after bone fractures (fractures), surgery on bones or infections. In addition to the type of infected tissue, bone inflammation and bone marrow inflammation also differ in their origin:

Bone inflammation occurs when bacteria reach the bone from the outside, for example in the case of an open injury or surgical wound. Which bones are affected exactly depends on the location of the causative injury. In contrast, bone marrow inflammation occurs when bacteria enter the bone via the bloodstream (hematogenous bone inflammation). Affected are mainly thigh (femur) and lower leg (tibia).

Bone inflammation: acute or chronic

Bone inflammation can be acute or chronic. The main symptoms of acute bone inflammation are redness, swelling, warming and pain in the affected area. It is first treated with antibiotics to kill the causative bacteria. In some cases, when the bone is already severely damaged, operative therapy is necessary.

Without therapy, acute bone inflammation can become chronic and the healing process can be extremely delayed. In chronic bone inflammation, the body tries to fight even the bacteria by forming a kind of capsule around the inflamed area. Within this capsule, however, the bacteria live on. There are pain and restricted mobility in the affected joint. From time to time, the interior of the capsule may empty to the outside in the form of pus.

Bone inflammation: frequency

The most common bone infection is that which occurs after surgery. It accounts for about 80 percent of all bone infections. For reasons not yet clarified, men are more frequently affected than women.

Haematogenous bone marrow inflammation (also endogenous or internal bone inflammation) occurs especially in children. The external bone infection (also exogenous or external bone inflammation) affects mainly adults. Acute bone inflammation turns into a chronic form in about 10 to 30 percent of all cases.

Special form: spondylitis

A special form of bone inflammation is spondylitis. The bones of the spine (vertebral body) are affected by the inflammation. Spondylitis is usually caused by the spread of bacteria through the blood, and doctors speak of hematogenous dissemination. The patients have very high fever and severe back pain, which usually intensifies at night and during exercise. Affected persons usually automatically take care of the back.

Bone inflammation: symptoms

Between a bone inflammation and a bone marrow inflammation the symptoms can in principle differ, since the way of the inflammation is different.

Bone marrow inflammation: symptoms

Bone marrow inflammation focuses on bacterial infection. Most sufferers feel tired and tired and suffer from general malaise and fever. After a few days, the first joint and limb pain occurs; External signs of inflammation are not yet apparent at the beginning. Only after a few days do affected areas swell. From the outside, a significant warming is felt.

Often bone marrow inflammation affects the knee and upper arm. The inflamed limbs are additionally flabby and painful. If joints are affected by the inflammation or the inflammation spreads dramatically in the bone, it can lead to instability and irreversible damage to the bone marrow. In children, the fever can rise up to 40 degrees. In addition, chills occur more frequently in children.

Bone inflammation: symptoms

Bone inflammation also causes pain. In addition, the affected area may be swollen and also show redness. In contrast to bone marrow inflammation, pus can leak out during bone inflammation, allowing it to be quickly diagnosed.

In chronic bone inflammation there are always long symptom-free intervals. Bone inflammation can then break out all of a sudden, showing again every symptom of an acute infection at each outbreak.

Bone inflammation: causes and risk factors

Bone inflammation and bone marrow inflammation are mostly caused by bacteria.

Physicians divide the bone inflammation according to the nature of their formation:

Hematogenous (endogenous) bone inflammation

When bacteria enter the bone via the bloodstream, inflammation can occur. This results in a bone marrow inflammation. The bacteria can in principle come from any bacterial infection, such as a middle ear infection, jaw infection or tonsillitis.

Posttraumatic (exogenous) bone inflammation

In the case of post-traumatic bone inflammation, bacteria have reached the bones from the outside, for example via an accident wound or infection of an operating room wound during the operation.

Fortified bone infection

At the edge of screws or plates that are introduced into the bone during an operation, the immune system can not act. So here bacteria can multiply undisturbed – a propagated bone infection arises.

Regardless of how the inflammation arose, it can in principle be caused by the following pathogens:

• staphylococci
• streptococci
• Other types of bacteria such as Salmonella, Haemophilus influenzae, Mycobacterium tuberculosis and Escherichia coli
• Rare viruses or bacteria

In bone inflammation, the outer, hard substance of the bone is affected by the inflammation, without involvement of the bone marrow. First, the periosteum surrounding the bone becomes inflamed. From there, the bacteria spread into the bark layer (Substantia compacta). There may also be only inflammation of the periosteum. However, doctors do not speak of bone inflammation anymore, but treat this finding as an independent disease.

In children, the growth areas of the long bones in the upper arm and thighs are particularly well supplied with blood, as the bones grow here. Therefore, the bacteria can get there more easily and trigger bone marrow inflammation than in adults. Such bone marrow inflammation may spread from the inside to the outside. First, only the bone marrow (myelitis) is infected, then the surrounding bone tissue (osteomyelitis). Bone marrow inflammation affects children whose immune system is weakened by underlying disease, malnutrition or medication.

Acute and chronic bone inflammation

Depending on the course of time, doctors differentiate between acute and chronic bone inflammation or bone marrow inflammation. An acute inflammation is caused by direct attack with bacteria. It can develop into chronic bone inflammation if therapy begins too late or is not properly completed. In the chronic form, the symptoms usually occur in batches. The body forms around the remaining bacteria a kind of capsule. The bacteria are included in this, but continue to multiply undisturbed there. From time to time they leak out in a purulent liquid. The following risk factors increase the risk of developing bone inflammation after an injury or surgery:

• malnutrition
• high age
• Nicotine, alcohol or drug use
• kidney failure
• liver weakness
• insufficient respiratory function
• Immune disorders due to HIV or immunosuppressive therapy
• malignant tumors
• Systemic diseases such as diabetes mellitus or arteriosclerosis

Bone inflammation: examinations and diagnosis

If a bone infection is suspected, the family doctor or a specialist in bone diseases is the right person to contact. In an initial interview (anamnesis), you have the opportunity to tell the doctor your symptoms and complaints exactly. This information may give initial evidence of bone inflammation. To be more specific about your case and to rule out other conditions, the doctor may ask additional questions such as:

• Did you suffer more in recent days from symptoms of illness such as fever or dullness?
• Have you had surgery in the past few days or weeks?
• At what points is the pain localized?

After the anamnesis, a physical examination takes place. First, the doctor scans those bones or joints that hurt. If a pressure pain occurs or if a clear swelling or redness becomes visible, this is another indication of a bone infection.

In addition, blood is taken and a blood picture made. Increased levels of white blood cells (leukocytes) and increased levels of C-reactive protein (CRP) indicate inflammation in the body.

If a joint is particularly swollen, the doctor can use a slightly thicker needle than the blood collection to perform a joint puncture. In this case, a sample of the joint fluid is taken, which is checked for the presence of certain bacteria.

With imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI), bone inflammation can be visualized. At a later stage, changes in the bone substance are also evident on an X-ray, but not at an early stage. With an ultrasound examination it can be determined whether additional soft tissues (for example muscles) are affected by the inflammation or if an articular effusion is present.

Brodie’s abscess

A special form of bone inflammation in childhood is the Brodie abscess. A painful swelling occurs in a certain defined area. The laboratory findings are usually inconspicuous and the symptoms are less pronounced. In the radiograph, however, the detachment of the periosteum from the bone can be recognized. MRI also shows changes in the bone structure.

Bone inflammation: treatment

In order to effectively treat bone inflammation, the triggering bacteria must be eliminated. These are given antibiotics. Since some types of bacteria are resistant to certain antibiotics, it must be determined before the treatment, which bacteria are responsible for bone inflammation.

Osteomyelitis therapy

In a bone marrow inflammation, it is usually sufficient to take the antibiotics orally (through the mouth). They are dissolved in the blood and, like the bacteria, enter the bone marrow via the bloodstream, where they can kill the bacteria.

Osteitis therapy

In case of bone inflammation oral antibiotics are in many cases not sufficient. Here, a surgical treatment of the inflammation can be done by the source of infection in an operation with rinses and antibiotic-containing deposits is supplied. If bony structures are already damaged by bone inflammation or the inflammation progresses despite antibiotic therapy, the affected bone tissue must be surgically removed. Removed parts of the bone are replaced with artificial implants so that the bone is stable again after healing. If there are foreign objects such as plates or screws in the affected bone and there is a risk that they hinder or hinder the healing, they are removed.

After the operation, various treatment options are available. If joints are affected by bone inflammation, small antibiotic-containing sponges are often used. In addition, a drainage can be placed outward through which wound secretions can flow out of the joint. If the site of inflammation is located on the extremities, a supporting splint is created from the outside after the operation, with which the inflamed bone is spared and relieved for a certain time until it has regenerated. If the bone infection is widespread or there is a high risk of re-inflammation (risk of recurrence), sometimes open wound healing takes place. The surgical wound is left open for a certain time after the operation and closed again later.

In some cases of bone inflammation, a single operation is not sufficient, but the affected area must be opened again – either to remove further inflamed tissue, or to reinstate previously removed support structures or implants. Even if there are no symptoms for a long time, years later, after the first operation, another inflammatory focus may develop (recurrence).

Complications of the operation

As with any other surgical procedure, there are certain risks associated with the operation of bone inflammation. During and after surgery, bleeding, bleeding and bruising may occur due to injury to blood vessels in the area. In addition, there is a risk that recurrent infections may occur or that there may be sensory disturbances due to the injury of nerves in the surgical area.

Very seldom, after the operation, there is a healing of the bones, a diminished mobility or a wrong merging of the bones. In addition, the so-called Sudeck syndrome can occur. In the process, the bone around the distant area is broken down and further painful inflammation occurs.

Bone inflammation: disease course and prognosis

The prognosis of bone marrow inflammation (osteomyelitis) or bone inflammation (osteitis) depends on the type of inflammation, the age of the patient, the strength of his immune system and the nature of the pathogens involved.

An acute bone marrow inflammation has a good chance of recovery. In the case of bone inflammation, healing without permanent damage is generally possible if it is detected and treated in good time. The treatment of chronic bone inflammation is more difficult. Especially in adults (less so in children) there is a risk that the bony inflammation in the chronic form passes.

The chances of recovery in children with bone marrow inflammation are generally better than in adults. In children, however, there is a risk of growth disturbance, when the osteomyelitis affects the growth joints of the bones. The growth joints are those parts of the bone that still consist of cartilage in children, from which constantly new bone substance is formed for a healthy growth in size. If this process is disturbed, it can lead to stunted growth and shortened arms and legs – depending on where the inflammatory focus is.

You can not prevent a bone infection. Especially in children, attention should be paid to bone and joint complaints. For signs of pain, it is best to see a doctor immediately. The risk of osteitis can be reduced, especially in children with a weak immune system, by removing susceptible structures and organs for chronic inflammation. These include, for example, the tonsils or the polyps. If there is a bacterial infection, antibacterial treatment with antibiotics is the best protection against one bone inflammation, However, it can not be prevented or excluded in general.