14. Bone Disorders: Osteomyelitis

Osteomyelitis

Bone infection, usually bacterial (Staphylococcus Aureus)

Pathophysiology

Pathogens enter bone (via bloodstream, open wound, or surgery) → inflammatory response → necrosis

Signs and Symptoms

• Localized bone pain and tenderness

• swelling, redness, warmth

• fever and chills

• restricted movements

Risk Factors

• Open fractures

• Orthopedic surgery or prosthetics

• Diabetes

• IV drug use

• Immunocompromised status

Diagnostics

1. Increased WBC, ESR, CRP

2. Blood Cultures: Identify Pathogen

3. MRI or Bone Scan: Detect early infection

4. Bone Biopsy: Confirm organism

5. X-ray: Shows late changes (sequestrum)

Nursing Management

• Monitor wound site for drainage

• Elevate affected limb

• administer IV antibiotics on time

• Educate on PICC line care (if discharged)

Pharmacologic Treatment

1. IV antibiotics: Eliminate infection

2. Analgesics: Pain control

3. Surgery: Debridement or amputation in chronic/refractory cases.

Surgical Interventions

🔪 Surgical Debridement

• Indication: Persistent or chronic bone infection unresponsive to antibiotics

• Purpose: Removes necrotic bone and tissue to eliminate infection

• Post-op: Wound care, culture-directed antibiotics, assess for signs of sepsis or recurrence

🦿 Amputation (last resort)

• Indication: Extensive bone destruction, non-healing infection, or systemic compromise

• Purpose: Prevent systemic spread of infection and preserve life

• Post-op: Emotional support, pain management, prosthesis planning, physical rehab