David A Thompson, MD
Fellow of the American Academy of Orthopaedic Surgeons
http://orthodoc.aaos.org/handmd
Guilford Orthopaedic & Sports Medicine Center
1915 Lendew Street
Greensboro, NC 27408 USA
Phone: 336-275-3325  | Fax: 336-275-5346
Copyright 2007 American Academy of Orthopaedic Surgeons
Infections

Orthopaedic infections can be devastating. Disease-carrying bacteria, viruses, and parasites that get into the body can destroy healthy tissue, multiply and spread through blood.

Infection of skin and other soft tissue can lead to infection of bones (osteomyelitis) and joints (septic arthritis). Without prompt treatment, orthopaedic infections can become chronic. Thus, even a small scratch on the fingertip has the potential to permanently disable your hand, or worse.

Fortunately, early diagnosis, appropriate antibiotic therapy, and surgical intervention when required can cure most infections and prevent permanent problems.

Prevention

To control the spread of infections in hospitals, doctors and nurses wear gloves and gowns and wash their hands frequently.

To prevent infections in skin wounds, follow these tips:

  • First control bleeding, and then clean the wound with soap and water.
  • Keep all foreign matter (i.e., hair, clothing, dirt and fluids) out of the wound.
  • Do not try to remove matter embedded in the wound.
  • Use sterile materials for the first dressing of the wound.
  • See your doctor for final, definitive cleaning of the wound.
Risk Factors

Having certain chronic diseases puts you at greater risk for infections. Examples include HIV, rheumatoid arthritis, diabetes mellitus, hemophilia, and sickle cell anemia. You can become infected through direct contact with an infected person or through indirect contact, as from a contaminated object.

Infections enter the body through breaks in the skin, especially puncture wounds and other injuries that are difficult to clean.

Sometimes, joint infections develop from an internal hip or knee replacement device (prosthesis). The knee is the most commonly infected joint.

Symptoms

An infection may cause redness, warmth, and inflammation around the affected area. The area may be stiff, drain pus, and lose range of motion. Infections can give you fever and chills.

Infants may act irritable and lethargic, refuse to eat, or vomit. Always suspect infection if your child has pain or swelling in the limbs, spine, or pelvis. The child may limp or refuse to walk.

Infections pose special risks to young children for a number of reasons:

  • Children under the age of 3 are easily infected. Their immune systems are not fully developed and they tend to fall down a lot, opening the skin to infection.
  • Infections spread quickly through a young child's circulation system and bone structure.
  • Damage to bones and joints caused by infection can harm a child's growth and lead to severe physical dysfunction. Infection of child's hip joint is a surgical emergency.
Diagnosis
  • See your doctor right away for early diagnosis and treatment if you suspect infection.
  • Tell the doctor about any chronic diseases that may affect treatment.
  • Describe the symptoms and when they began. Was there a previous infection? Were you recently injured? Have you ever had surgery?
  • Your doctor may ask you to move the affected area to determine if motion increases pain.
  • If the patient is a child (especially an infant) the doctor may examine the rest of his or her body for other possible sites of infection.
  • Sometimes infected bones do not show symptoms (subclinical osteomyelitis).
  • Your doctor will probably take X-rays or use more sophisticated imaging tools, such as MRI (magnetic resonance imaging) scans to see the extent of damage to bone and soft tissue. The doctor may need to take blood samples and remove fluid from the infection using a needle-syringe (aspiration).
  • Laboratory tests on these samples can help identify bacteria or other organisms causing the infection.
Treatment

Your doctor may prescribe antibiotics that you take through a vein (intravenous, or IV) or swallowed by mouth (orally).

Soft-Tissue Infections

Many types of infections affect skin and other soft tissue. Common among them are:

  • Paronychia: Appears along the edge of a nail
  • Felon: Infects the pulp of a fingertip
  • Impetigo: Appears as a blister in young children or a yellow crusted ulcer in older people)
  • Furuncle: Infects a hair follicle
  • Tenosynovitis: Infects the flexor tendons of a finger or thumb

In some cases, soft-tissue infections may be treated simply with warm water soaks and application of a dry, sterile bandage.

In other cases, your doctor may need to drain the infection after giving you a local anesthetic for pain relief.

You may need to apply ointments to the infection or take antibiotics to treat it.

Bone Infections

Depending upon severity and other factors, osteomyelitis can cause irreversible damage (necrosis) to bone cells.

Your doctor will probably prescribe antibiotics and may need to drain the infection and/or cut away (debride) dead bone and other infected tissue.

Difficult cases can require amputation.

Joint Infections

Like osteomyelitis, treatment of septic arthritis often requires antibiotics and prompt surgical drainage.

Your doctor may repeatedly aspirate the joint or use other techniques that cut into bone to remove inflammatory cells.

Antibiotic Resistance

Antibiotics successfully treat most infections caused by bacteria. However, some microorganisms are developing resistance to standard antibiotic treatments. Each time you use an antibiotic, bacteria resistant to treatment may survive and multiply. These bacteria can create infections for which there is no treatment. Resistant bacteria may spread to other people, posing a major health threat for everybody.

It is important to follow the directions of your physician and take all of the pills prescribed, even if you feel well before they are gone.

Last reviewed: July 2007
AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS "Find an Orthopaedist" program on this website.
Copyright 2007 American Academy of Orthopaedic Surgeons
OrthoInfo
The American Academy of Orthopaedic Surgeons
6300 N. River Road
Rosemont, IL 60018
Phone: 847.823.7186
Email: orthoinfo@aaos.org

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