Types of Osteomyelitis

NYU Langone physicians are experienced in identifying and treating bone infections, known as osteomyelitis. These infections begin when disease-causing bacteria or other germs enter the body. Germs can spread to the bones through the bloodstream or from nearby tissues or joints. Sometimes these infections occur after physical trauma or a surgical procedure directly exposes a bone to bacteria or other germs. Without prompt treatment, acute—meaning short-term—bone infections can become chronic—long-term—conditions.

Many types of bacteria can cause bone infections, but the most common is Staphylococcus aureus, often called staph. Fungi and other germs can also cause these infections, but these are less common.

Types of Osteomyelitis

Osteomyelitis may occur when an infection elsewhere in the body, such as a urinary tract infection or pneumonia, spreads through the blood to the bones. This type of bone infection is known as hematogenous osteomyelitis. Any open or penetrating wound can expose bone to bacteria, causing contiguous osteomyelitis, also called non-hematogenous osteomyelitis.

In adults, most bone infections are due to physical trauma. An open wound over a bone can also lead to contiguous osteomyelitis. This condition is common in people who have foot ulcers due to diabetes. It also can develop in people who have peripheral neuropathy, in which nerve damage caused by diabetes or another condition makes it difficult to detect an injury in the limbs.

Osteomyelitis can develop rapidly and may be accompanied by pain, fever, and stiffness. Symptoms may appear within days.

Chronic osteomyelitis progresses slowly and may be the result of a previous bone infection. Despite multiple courses of antibiotics, the condition may return if the bacteria causing the infection become resistant to antibiotics or if there was an incomplete removal of infected or dead bone. Some bacteria can live and lie dormant in healthy bone tissue for many years before causing problems. Symptoms of chronic osteomyelitis may include pain and redness or drainage from either a nonhealing wound or an abnormal opening between the infected bone and the skin’s surface.

Adults are more likely than children to develop osteomyelitis in the vertebrae—the bones of the spine—or in a part of the body where they have previously had surgery for a fracture.

In children, osteomyelitis usually affects the long bones in the legs and upper arms, such as the femur and the humerus. It is more likely to develop after a recent illness. Symptoms may include fever, chills, redness at the site of infection, pain or tenderness over the affected bone, and difficulty using the affected limb. Children with osteomyelitis may, for instance, have trouble walking due to severe pain in the legs. These patients should be treated by a pediatric orthopedic surgeon.