Osteomyelitis is caused by direct or indirect invasion of an organism into the bone or its surrounding tissue. Any break in the skin, which normally acts as a protective barrier, can lead to direct infection. These breaks may be caused by abrasions, open fractures, or surgical instrumentation, such as the insertion of pins for skeletal traction. Indirect infections are caused by organisms that are transported through the bloodstream (hematogenous) from an infection in a distant site, such as otitis media, tonsillitis, or a furuncle (boil). The most common organisms responsible for osteomyelitis are Staphylococcus aureus and hemolytic streptococcus.

Previous trauma to a bone may predispose the area to osteomyelitis. Any delay in treatment of a fracture may also contribute to the development of osteomyelitis. Hematogenous osteomyelitis (originating in the blood) may occur in the adult who has undergone surgery or examination of the genitourinary tract or whose resistance has been lowered by debilitating illness. With older patients, the infection may become localized in the vertebra.

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