Inflammation in the bone

introduction

The human bones consist of an outer compact envelope ( Compacta ) and an internal porous spongiosa containing the bone marrow.
While an isolated inflammation of the outer compacta is called osteitis, bone marrow involvement is called osteomyelitis. In everyday life, the terms mentioned are often used interchangeably.

An inflammation in the bones is a serious disease, which is often accompanied by general symptoms such as fever and weakness and usually makes an antibiotic treatment necessary.
The treatment is often lengthy, with the chances of recovery depending on the pathogen, the spread of inflammation and any complications.

symptoms

The symptoms of inflammation in the bones are initially the cardinal symptoms of any inflammation.
In addition to redness and swelling, this also includes pain and functional limitations, such as decreased mobility in the joint.
The symptoms mentioned can also occur individually, as well as the order of their occurrence is variable.

In addition, it can lead to systemic symptoms such as fever and fatigue. In the blood, increased inflammatory values ​​such as leucocytes or CRP can be detected.

A distinction is made between acute and chronological events.
Chronic outcomes are commonly seen in patients with limited immune systems (eg, immunosuppressive medication or diseases such as diabetes) and multidrug-resistant bacteria.
The multidrug-resistant bacteria are resistant to several types of antibiotics and are often produced and spread in hospitals.

As a complication of inflammation in the bone, abscesses and fistulas (connecting ducts) can form. In some cases bone fractures may occur due to the destruction of the bone tissue.

causes

An inflammation in the bone can occur locally (locally) and thus limit itself to a bone section.
This is mainly due to open fractures, whereby the bone has direct contact with the environment and bacteria, so it can come to osteitis or osteomyelitis.

Also, medical measures such as surgery on the bone, the introduction of foreign material such as screws or plates, or a sampling ( biopsy ) can lead to local inflammation in the bone.

Bacterial pathogens such as streptococci or staphylococci are the most common causes of inflammation in the bones, more rarely are viruses, parasites and fungi in question.

In addition to an injury or medical measure also comes a blood poisoning ( sepsis ) with spread of the pathogens throughout the body as a cause of bone inflammation into consideration. Here, not infrequently several bones are affected by the inflammation and it comes to heavy progressions.

  • Bone duct inflammation on the tailbone
  • So long does a periostitis

therapy

The therapy depends on the spread of the inflammation and the causative agent.

If multiple bones and the surrounding soft tissue are affected or if a multi-resistant germ is present, the prognosis worsens and more aggressive therapies are necessary.

If the bone infection is caused by bacteria, as is usually the case, the cause can be treated causally with antibiotics. The antibiotics can be administered in tablet form or as an infusion to reach the site of action. Optimally, the antibiotic therapy is targeted after identification of the causative bacterium.

If bone or soft tissue has died (necrosis), surgical debridement may be necessary to prevent it from spreading and causing further damage.
During such an operation, the affected area may also be flushed with antibacterial and sterilizing solutions and drainage may be applied to expel pus.
Furthermore, antibiotic-soaked sponges can be used, which dissolve themselves and do not need to be removed. Thus, high concentrations of the antibiotic can be achieved on site. As a result, further operations may be necessary to maintain the stability of the bone and thus patient mobility.

  • Hyperbaric oxygen therapy
  • Osteomyelitis therapy

diagnosis

Bone inflammation can be diagnosed clinically, by laboratory chemistry or by imaging.

Typical clinical symptoms include redness, swelling and severe pain, as well as lymph node swelling in the affected area. It usually comes to functional impairment as well as fever and fatigue. Fistula and abscess formation are also possible.

In a blood test, inflammatory parameters such as ESR (erythrocyte sedimentation rate) or leucocyte count are increased.

Imaging procedures such as X-rays, MRI and CT can show how far the inflammation has spread and how much the bone has been damaged.

Finally, a biopsy, ie a tissue sampling, exclude further differential diagnoses (eg bone tumor).

Bone inflammation in the jaw

A bone infection in the jaw is not uncommon and can often emanate from the dental system (odontogenic infection). Infections in the oral cavity or the sinuses can spread to the bone. Common causes of bone inflammation in the jaw are Staphylococcus aureus and streptococci. In general, the lower jaw is affected many times more frequently than the upper jaw, as his blood supply is poorly organized.
Infections such as tooth decay, inflammation of the periodontium (periodontitis), a purulent sinusitis or those due to an upper or lower jaw fracture can spread to the jawbone and trigger inflammation there. Furthermore, cysts and abscesses in the oral cavity may be the cause of a jawbone infection.
A spread of bacteria from the oral cavity through wounds to the bone can be done while pulling a tooth ( tooth extraction ). Also, a transmission of bacteria via the bloodstream to the jawbone can be the cause of inflammation in the jawbone in rare cases.

If the severity of the inflammation allows it, one should first try to control the inflammation with antibiotics. The therapy should be carried out consistently for at least three to four weeks.
If the drug treatment is not promising, the inflammation must be surgically eliminated. It may be necessary to remove individual teeth. In the extreme case, the affected jawbone is removed and a graft inserted in its place.
The primary goal of therapy, however, is to preserve the bone and its function.

Diagnosis of jawbone inflammation

The attending physician can often put the diagnosis of inflammation in the jawbone out of the clinical picture.
In addition to redness and swelling in the affected area of ​​the jaw, there is also some severe pain. It is not uncommon for fistulas (connecting ducts) or abscesses to form. In part, the swelling visible from the outside as a "thick cheek" impress. Also swelling of adjacent lymph nodes in the neck area (see: Lymphadenopathy at the neck) is conceivable. In some cases the affected persons complain of strong bad breath. In addition, fever and the rise of inflammatory parameters such as erythrocyte sedimentation rate (ESR) or white blood cell count may occur.

Finally, an X-ray of the jaw can provide information about the presence and progression of inflammation in the bone. Often, however, x-ray inflammation in the X-ray can only be seen late, whereas in more complex procedures such as CT, MRI or bone scintigraphy, it can be seen much earlier.

However, a reliable diagnosis can only be made by a tissue sample ( biopsy ). Here also the most important differential diagnosis, a bone tumor in the jaw, can be excluded. A distinction is also made between an acute and a chronic form, which can persist untreated for months and years.

Bone inflammation in the ear

Middle ear infections or inflammations of the ear canal can spread to adjacent bones such as the temporal bone and cause bone inflammation there.

In the case of otitis externa maligna (a severe form of inflammation of the ear canal), there is a strong inflammation of the external auditory canal, which spreads to bones and cerebral nerves. The causative agent is often a bacterium called Pseudomonas, which mainly affects patients with weak immune systems (such as diabetics).

In addition to severe pain, it can come to the discharge of secretions from the ear. In addition, patients develop a strong feeling of being sick with fever and increased inflammatory levels in the blood.

First the doctor (usually an ENT specialist) receives a mirror of the ear canal with a special device. With CT or MRI imaging, the extent of inflammation can be assessed, but clear digestion will only result in sampling, which may also preclude malignant deterioration.
If antibiotic therapy fails, the inflamed tissue must be surgically cleared and, if necessary, a bone graft used.

Bone inflammation in the leg

Inflammation in the bones in the area of ​​the leg can, on the one hand, be absorbed via the bloodstream in the form of circulating bacteria ( endogenously ) or from the outside ( exogenously ) from the environment into the bone.
This can be done by infections of the skin and soft tissue, which spread to the bone.
Bone fractures of the lower extremity can also cause bacteria to enter the bone and cause inflammation there. Finally, pathogens may enter the bone through surgery and foreign matter such as plates or screws or leg specimens.

Symptoms may include swelling, pain and redness in the affected leg, as well as general malaise and fever.

The doctor makes the diagnosis on the one hand from the clinical picture of his patient, as well as from increased inflammatory parameters in the blood and imaging techniques such as X-rays, CT, MRI or scintigraphy procedures.
In some cases it may be necessary to take a sample to examine it microscopically. Thus, the most important differential diagnosis, a tumor of the bone, can be excluded.

Once the doctor has confirmed the diagnosis, antibiotic therapy should be started. If this does not lead to a decrease in inflammation, it must be surgically eliminated.
If the bone infection is based on infected foreign matter such as screws or nails in the body, it must always be removed surgically in order to facilitate a cure.
If adequate treatment is lacking, the inflammation may become chronic and persist for months to years, leading to the gradual destruction of bone tissue.

Bone inflammation in the knee

Bone inflammation in the leg can also affect the joint area of ​​the knee. The pathogens can either be flushed through the bloodstream in the joint bones or get into the bone by an external injury.

The inflammation in the bone manifests itself symptomatically as swelling, overheating, reddening and pain over the affected knee joint. Also, the mobility can be limited.

Again, a distinction is made between an acute and a chronic form.
In some cases it is difficult to differentiate from inflammatory degenerative diseases of the knee joint such as arthritis.

An examination of inflammatory levels in the blood, as well as imaging techniques such as CT or MRI can provide information about a possible inflammation.

If the doctor has made the diagnosis of bone inflammation, therapy in the form of antibiotic therapy should be started immediately. If the desired success can not be achieved with the drug therapy, an operative elimination of the inflammation must be considered.
In any case, the course of therapy should be strictly monitored, otherwise the progressive destruction of bone and joint threatens. Loss of exercise and chronic pain can be the result.

  • Inflammation in the knee.
  • Periostitis on the knee

Bone inflammation in the foot

An inflammation of the bones in the foot can have different causes. One possibility is that a non-healing wound on the foot becomes infected and penetrates inwards until the infection of the bone occurs. On the other hand, open bones can cause bacteria from the environment to come into direct contact with the bone and bone marrow, triggering inflammation in the bones of the foot. Rarely, an inflammation of the foot bones is caused by bacteria in the blood, which penetrate through blood vessels into the bone and can infect him there.

Symptomatic is an inflammation of the foot bones due to a local redness, pain and functional limitations. For example, movement in the joints may be restricted.
It can also lead to systemic symptoms such as fever and fatigue.

If there is a suspicion of an inflammation of the bones in the foot, the doctor initiates an immediate therapy. This usually consists of the administration of antibiotics, since such inflammations are bacterial in most cases. If the medical therapy does not show the desired success or if the inflammation spreads systemically or to soft tissue, it may be necessary to eliminate the inflammation surgically and, if necessary, replace the bone with a prosthesis. The goal of any therapy, however, is initially the preservation of the bone and its function.

Bone inflammation in the toe

Inflammation in the bone can also occur on one or more toes. A common reason for this are non-healing wounds on the toes ( ulcers ). These are particularly common in long-standing diabetics or circulatory disorders of the legs (PAOD or peripheral arterial occlusive disease).

If the wounds persist for several weeks and are deep and extensive, there is a risk of spreading the infection to the bone. In some cases, the wound is so deep that the bone surface is already visible from the outside.

More evidence of inflammation of the toe bones can be general redness, swelling and pain in the toes. Mobility in the toe joints may be limited.

If there is a suspicion of inflammation of the toe bones, the physician will make the diagnosis through the clinical judgment of the affected toe and through inflammatory parameters in the blood.
X-rays can also shed light on inflammation and bone destruction. In any case, adequate therapy should be started immediately, usually with the administration of antibiotics. In severe cases, surgical removal of the inflamed tissue is required to prevent the inflammation from spreading to the surrounding tissue and adjacent bones.


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