Osteomyelitis from Bedsores

What Is Osteomyelitis?

Osteomyelitis is an infection of the bone caused by bacteria or, less commonly, fungi. The infection can reach the bone through three primary routes: through the bloodstream (hematogenous), from adjacent infected tissue (contiguous), or through direct introduction during trauma or surgery. In the context of pressure ulcers, osteomyelitis occurs through contiguous spread—bacteria from the infected wound migrate through damaged soft tissue to reach the underlying bone.

Once established in bone, infections are notoriously difficult to eradicate. Bone has relatively poor blood supply compared to soft tissue, limiting the delivery of immune cells and antibiotics to the infection site. The bacteria can also form biofilms—protective communities that shield them from the immune system and antibiotic therapy—making treatment even more challenging.

How Bedsores Cause Bone Infections

The progression from pressure ulcer to osteomyelitis follows a predictable pattern that facilities should recognize and interrupt:

Deep Wound Development

Osteomyelitis most commonly develops from Stage 3 and Stage 4 pressure ulcers, where tissue destruction extends through the full thickness of skin into subcutaneous tissue, muscle, and potentially bone. Stage 4 ulcers, by definition, may have visible bone, tendon, or muscle in the wound bed, creating direct exposure to pathogens.

Wound Infection

When deep pressure ulcers become infected, bacteria multiply within the wound bed. Common pathogens include Staphylococcus aureus (including MRSA), Streptococcus species, Pseudomonas aeruginosa, and various anaerobic bacteria. These organisms can spread through the damaged tissue layers toward the bone.

Bone Invasion

Once bacteria reach the bone surface, they can penetrate the periosteum (the outer membrane covering bone) and invade the bone matrix itself. The infection triggers an inflammatory response that paradoxically can damage bone further, creating areas of dead bone (sequestrum) that harbor bacteria and impede healing.

High-Risk Locations

Pressure ulcers near bony prominences carry the highest osteomyelitis risk because there is less soft tissue between the wound and bone:

• Sacrum and coccyx – The most common bedsore location, with relatively thin tissue overlying bone
• Ischial tuberosities – Sitting bones vulnerable in wheelchair-bound patients
• Greater trochanters – Hip bones susceptible in side-lying patients
• Heels – Minimal soft tissue protection over the calcaneus

Treatment Challenges

Osteomyelitis is one of the most difficult infections to treat, particularly in elderly and debilitated patients who commonly develop bedsores:

Prolonged Antibiotic Therapy

Bone infections typically require 4 to 6 weeks of intravenous antibiotics, followed by additional weeks or months of oral antibiotics. Patients often need a PICC line or central catheter for long-term IV access, carrying additional risks of line infections and complications.

Surgical Intervention

Many cases of osteomyelitis require surgery to remove infected and dead bone tissue (debridement). Surgical options may include:

• Debridement – Removal of infected soft tissue and bone
• Sequestrectomy – Removal of dead bone fragments that harbor bacteria
• Bone resection – Removal of larger sections of infected bone
• Amputation – In severe cases, particularly of the extremities, amputation may be necessary
• Flap coverage – Surgical reconstruction using tissue flaps after infection control

Chronic and Recurrent Infection

Despite aggressive treatment, osteomyelitis frequently becomes chronic or recurs. Studies show recurrence rates of 20-30% even after appropriate treatment. Patients may require multiple surgeries and repeated courses of antibiotics over years. Some infections are never fully eradicated and require lifelong suppressive antibiotic therapy.

Long-Term Consequences

Osteomyelitis from pressure ulcers can result in devastating and permanent consequences:

Permanent Disability

• Bone destruction – Loss of bone structure can impair mobility and function
• Chronic pain – Ongoing bone infection and damage cause persistent pain
• Joint involvement – Infection can spread to nearby joints, causing septic arthritis
• Pathologic fractures – Weakened bone may fracture with minimal stress

Amputation

When osteomyelitis cannot be controlled through antibiotics and debridement, amputation may become necessary to save the patient's life. This is particularly common with heel osteomyelitis, which may require below-knee amputation. For elderly patients, amputation carries high rates of mortality and loss of independence.

Sepsis and Death

Bone infections can serve as a continuous source of bacteria entering the bloodstream, leading to sepsis. Patients with chronic osteomyelitis remain at elevated risk for septic episodes, which can be fatal, particularly in frail elderly patients.

Legal Accountability

When patients develop osteomyelitis from pressure ulcers, it typically represents multiple failures in the standard of care. Healthcare facilities may be held liable for:

Failure to Prevent Deep Pressure Ulcers

Osteomyelitis requires deep wounds that reach bone. Facilities that fail to prevent Stage 3 and Stage 4 pressure ulcers through proper repositioning, pressure redistribution, nutrition, and skin monitoring set the stage for bone infection.

Delayed Recognition of Wound Progression

Regular wound assessment should identify when pressure ulcers are deepening or showing signs of infection. Delayed recognition allows wounds to progress to the point where bone becomes exposed or infected.

Inadequate Infection Treatment

When wound infections develop, they require prompt and appropriate treatment. Failures include:

• Delayed antibiotic therapy
• Inadequate wound cultures to identify pathogens
• Failure to refer for surgical evaluation
• Poor wound care technique that spreads infection

Failure to Diagnose Osteomyelitis

Deep wounds near bone should prompt evaluation for osteomyelitis through imaging (MRI or bone scan) and potentially bone biopsy. Delayed diagnosis allows infection to become more established and harder to treat.

Recoverable Damages

Patients and families affected by pressure ulcer-related osteomyelitis may be entitled to compensation for:

• Medical expenses including prolonged hospitalization, surgery, IV antibiotics, and rehabilitation
• Pain and suffering from the infection and treatment
• Loss of limb or function if amputation is required
• Long-term care needs
• Lost quality of life and independence
• Wrongful death damages if osteomyelitis contributes to death

Diagnosis of Osteomyelitis

Diagnosing osteomyelitis in pressure ulcer patients requires a high index of suspicion and appropriate testing:

Clinical Signs

• Deep wound that probes to bone (positive probe-to-bone test)
• Exposed bone in the wound bed
• Wound that fails to heal despite appropriate care
• Persistent drainage or foul odor
• Signs of systemic infection (fever, elevated white blood cell count)

Imaging Studies

• X-rays – May show bone destruction, but changes take 2-3 weeks to appear
• MRI – Most sensitive for detecting early bone infection and extent of involvement
• Bone scan – Can identify areas of infection but less specific than MRI
• CT scan – Useful for surgical planning

Laboratory Testing

• Elevated inflammatory markers (ESR, CRP)
• Elevated white blood cell count
• Blood cultures to detect bacteremia
• Bone biopsy for definitive diagnosis and pathogen identification

Documenting Bedsore-Related Osteomyelitis

If your loved one has developed osteomyelitis from a pressure ulcer, thorough documentation is essential:

1. Request complete medical records including wound care logs, nursing assessments, imaging reports, lab results, and surgical records
2. Document the wound history showing how the pressure ulcer developed and progressed over time
3. Obtain all imaging studies including X-rays, MRI, and bone scans
4. Record treatment timeline including when infection was first suspected, diagnosed, and treated
5. Note any surgical procedures including debridement, bone resection, or amputation
6. Document ongoing consequences such as chronic pain, disability, or need for ongoing treatment

When to Seek Legal Help

If your loved one developed osteomyelitis from a bedsore in a nursing home, hospital, or other care facility, you should consult a bedsore attorney if:

• A pressure ulcer developed or significantly worsened while under facility care
• The wound was allowed to progress to Stage 3 or Stage 4 before intervention
• Signs of wound infection were present before osteomyelitis developed
• There was delay in diagnosing or treating the bone infection
• Your loved one required surgery, including debridement or amputation
• Your loved one suffered permanent disability from the bone infection
• Your loved one developed sepsis from the bone infection
• Your loved one died from complications of osteomyelitis

At Traction Law Group, we understand that osteomyelitis from pressure ulcers represents a profound failure in patient care—a preventable tragedy that unfolds when facilities allow wounds to progress unchecked. We help families investigate how bone infections developed, hold negligent facilities accountable, and recover compensation for the devastating harm caused. Contact us for a free, confidential consultation. There is no fee unless we win your case.