Issue link: http://viewer.e-digitaledition.com/i/872903
Bill had kicked off his shoes to play Frisbee in the park when he stepped on a piece of glass, cutting his foot. Two weeks later, the wound was still painful, not healing well and had begun to ooze a yellowish discharge. IN ADDITION, BILL developed a fever and chills—common symptoms indicating infection. He called his doctor's office to make an appointment. The doctor examined the cut on Bill's foot and then ordered a blood test that confirmed an elevated white blood count. Another blood test uncovered inflammation suggestive of osteomyelitis—a bacterial infection in the bone. Osteomyelitis can occur in one bone or simultaneously in multiple bones. It can result from an infection like a tooth abscess or urinary tract infection that migrates through the bloodstream before settling in the bone. More commonly, it begins near the site of an open wound or compound fracture. People who smoke and those with chronic illnesses are at higher risk for developing this infection. Disrupted blood flow due to diabetes or peripheral vascular disease can also cause osteomyelitis, usually in the foot. Symptoms vary, depending on how the infection originates, and can include swelling, redness and pain. FIRST-LINE TREATMENT After finding inflammation and taking x-rays, Bill's doctor ordered a bone scan and a bone biopsy to confirm the diagnosis and pinpoint the type of bacteria causing the infection. OSTEOMYELITIS: INFECTION OF THE BONE "Treatments for osteomyelitis include IV [intravenous] or oral antibiotics, depending on the medication and the patient's reaction to it," says Henry Tischler, M.D., chief of orthopedic surgery at NewYork-Presbyterian Brooklyn Methodist Hospital. "In certain cases, the affected area may need to be immobilized to reduce pain and give the wound a better opportunity to heal." If the wound does not heal following these treatments, hyperbaric oxygen therapy (HBOT) may be used to speed the healing process by increasing the amount of oxygen to the patient's blood and tissues, says Todd Mundy, M.D., wound care specialist and emergency medicine doctor at NYP Brooklyn Methodist. "Delayed diagnosis and treatment may lead to damaged bone and may necessitate surgery to remove the dead tissue and replace it with bone grafts," Dr. Tischler says. "Delayed treatment may also cause prolonged osteomyelitis, which is often more difficult to treat." "If you suspect an infection—especially if you have diabetes or peripheral vascular disease—it is important to consult a doctor so that treatment can begin right away," Dr. Tischler says. FA L L 2 017/ / W W W.N Y P.O RG / BRO OKLY N 12 A N A T O M Y I N S I D E R 12