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from the American Academy of Orthopaedic Surgeons

Diseases & Conditions

Treatment

Recovery

Staying Healthy

Infections

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 certain types of scratches on the fingertip have the potential to permanently disable your hand, depending on the bacteria involved.

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; 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.

Cause

Infections can enter the body through breaks in the skin, especially puncture wounds and other injuries that are difficult to clean. Disease-carrying bacteria, viruses, and parasites that get into the body can destroy healthy tissue, multiply and spread through blood.

You can become infected through direct contact with an infected person or through indirect contact, as from a contaminated object.

Having certain chronic diseases puts you at greater risk for infections. Examples include HIV, rheumatoid arthritis, diabetes mellitus, hemophilia, and sickle cell anemia. These chronic diseases affect the ability of your immune system to fight off infections.

Sometimes, joint infections develop around an internal hip or knee replacement device (prosthesis). The knee is the most commonly infected joint. Learn more: Joint Replacement Infection 

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.

Infections in Infants and Children

Children under the age of 3 years are especially at risk of becoming infected. Their immune systems are not fully developed, and they tend to fall down a lot, opening the skin to infection. Infections pose special health risks for this age group because:

  • 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.

Watch for these signs of infection in an infant or young child:

  • Infants with infections may act irritable and lethargic (tired or out of it), refuse to eat, or vomit.
  • A child with an infection may limp or refuse to walk.
  • You should suspect infection if your child has pain or swelling in the limbs (arms or legs), spine, or pelvis.

Doctor Examination

If you suspect that you or your child have an infection, go to the doctor right away for early diagnosis and treatment.

Physical Examination

  • 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 or your child recently injured? Have you or your child ever had surgery?
  • Your doctor may ask you or your child 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 their body for other possible sites of infection.
  • Sometimes infected bones do not show symptoms (subclinical osteomyelitis).

Tests

  • The doctor will probably take X-rays and possibly order other imaging tests, such as magnetic resonance imaging (MRI) scans to see the extent of infection in the bone and soft tissue.
  • The doctor may need to take blood samples and remove fluid from the infected area using a needle-syringe (aspiration). Laboratory tests on these samples can help identify bacteria or other organisms causing the infection.

Treatment

The doctor may prescribe antibiotics that are given 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 (soft padded area) of a fingertip
  • Impetigo: Appears as a blister in young children or a yellow crusted ulcer in older people
  • Furuncle: Infects a hair follicle
  • Infectious tenosynovitis: Infects the flexor tendons of a finger or thumb (not to be conused with de Quervain's tenosynovitis)

Treatment

  • In some cases, soft-tissue infections may be treated simply with warm water soaks and application of a dry, sterile bandage.
  • In other cases, the doctor may need to drain the infection after giving you or your child 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.

Treatment

  • The doctor will probably prescribe antibiotics.
  • They may need to perform a surgery to drain the infection and/or debride (remove) dead bone and other infected tissue.
  • Difficult cases can occasionally require amputation.

Joint Infections

Like osteomyelitis, treatment of septic arthritis often requires antibiotics and prompt surgical drainage and debriding (removing the infected tissue).

Treatment

  • The doctor may repeatedly aspirate the joint. In an aspiration, the doctor uses a syringe and needle to remove fluid.
  • They may use other techniques that cut into bone to remove inflammatory cells.

Antibiotic Resistance

Antibiotics successfully treat most infections caused by bacteria.

However, some micro-organisms are developing resistance to standard antibiotic treatments. Each time you use an antibiotic, bacteria that are resistant to treatment may survive and multiply. These bacteria can create infections for which there is no treatment. Resistant bacteria may also spread to other people, posing a major health threat for everybody.

If you are given oral antibiotics to take at home, it is important to follow the doctor's instructions and finish the prescription, even if you feel well before all of the medication is gone. In other words, there should not be any leftover prescription medication unless your doctor tells you to stop taking the medication — for instance, if they switch you to a different medication.

Last Reviewed

May 2024

Contributed and/or Updated by

Aaron Chamberlain, MD, FAAOS

Peer-Reviewed by

Thomas Ward Throckmorton, MD, FAAOS

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.