OSTEOMYELITIS
…infections of bone and joint …
Bone infection, called osteomyelitis in medical terminology is a severe complication of surgery and trauma. Many times through reasons we cannot control, bacteria are able to make their way into bone. Once they colonize the bone it becomes very difficult to eradicate them. Many times patients are on extended 6 - 8 week courses of oral or intravenous antibiotics and just when all signs of infection have gone away the swelling and pain return. It is very difficult for antibiotics alone to be able to penetrate the bone enough to kill all of the bacterial cells. WHY ? - Because the we rely on the concentration of antibiotics in a patients blood to be high enough to affect the bacteria; it is possible that the patients overall health may not allow this proper blood level absorption.
Another reason is blood flow circulation, even if a patient has enough antibiotic flowing in their blood they may not have enough healthy circulation to the particular bone area that needs the antibiotic ( bone does not the greatest flow of blood when compares to other organs in the body to begin with ).
Another reason may be the antibiotic itself. Many oral pill antibiotics simply do not get to enough of a blood level to effect bacteria hiding in bone. This is due to how the tablets are absorbed in the stomach. There are a few on the market that do give the same levels as the intravenous types that are injected daily in the patient.
Another reason may be that most antibiotics are able to kill bacteria but only when the bacteria is active. Part of a bacteria life cyle is a sort of hibernation where they are inactive. So if a bacteria is dormant during when the patient is taking the antibiotic it may survive. This is why the course of antibiotics someone has to take is so long; to make sure that all of the bacteria in the bone have a chance to 'wake up' and be killed by the antibiotic.
And another reason is if there is metal ( screws, plates, pins etc. ) or other foreign materials in the body the bacteria can attach themselves to it, create a colony and become extremely resistant to any antibiotic since they will infect all the small metal crevases that hav eto blood flow and no ability to recieve antibiotic.
WHAT DO WE DO IN THESE CASES :
Osteomyelitis is a problem that may be best treated with surgery. To remove as much of the bacterial colony and the destroyed bone as possible to then allow the body and the antibiotic to clear out any cells left behind.
Many times we make antibiotic cement ( not same as building cement - its made from polymethylmethacrylate with antibiotics mixed in with it ) We put in the antibiotic we know will address the exact bacteria that infected the patient. This local delivery of antibiotic creates extensive local levels able to kill any bacteria present and is a more direct way of killing infection colonized bone. In some cases we can actually sculpt and create new bones out of cement and replace the infected bones completely.
If there is surgical hardware in the patients body at the site of infection we remove all of it immediatly. If necessary we can replace it with external fixators which are almost like scaffolds we apply on the patient leg to hold any nonhealed bones together until they heal up. These fixators can be used in cases of bone infection, they do attach to the bone but far enough away from the infected site and they are removed at end of treatment.
Open wounds ? We try to close them as well with muscle flaps. This helps in two ways: to close an open portal of entry of bacteria into a limb and to bring a healthy muscle in contact with the diseased bone. this muscle has excellent blood flow and provides more circulation to the bone adjacent to it.
To learn about how we deal with wounds click HERE.
In cases of severe bone loss we grow new bone through the process of distraction osteosynthesis- an procedure developed in the 1950s but rarely used here simply because its hard to learn as a doctor. We are lucky that we were able to learn these techniques of bone regeneration at the Ilizarov Medical Center in Kurgan, Russia over the past 10 years through about 15 visits there for training. Why so far? Thats where the procedure was invented and to this day they are the leading innovators on that particular topic. If you want to know more about this topic CLICK HERE.
Any other questions - email us Dr. Gitlin will get back to you with information. If you need to visit us call our office.