Can a wound infection get into the bone?

Yes. Bone infection (osteomyelitis) is one of the complications of untreated cellulitis, and it is one of the reasons wounds do not heal well. This page doesn’t give a symptom checklist for it — a wound that isn’t healing is the finding to act on.

Yes. Bone infection is a known complication, and it comes up in more than one way.

Bone infection — osteomyelitis — is one of the possible complications if cellulitis is not treated or treatment does not work. Others include blood infection (sepsis); inflammation of the lymph vessels; inflammation of the heart; infection of the membranes covering the brain and spinal cord; shock; and tissue death.

It comes up again from the other direction. Bone infection is one of the reasons wounds may not heal well. And the common types of non-healing wound treated at a wound care center include foot ulcers due to diabetes, poor blood flow, chronic bone infection, or swollen legs. Chronic bone infection is on that list as a reason a wound does not close.

It matters for treatment too. Although case reports have described negative pressure wound therapy used on wound beds with active osteomyelitis without bad outcomes, this is not considered standard of care.

How deep a wound reaches is part of why this matters. A stage IV pressure injury is one that has become so deep that there is damage to the muscle and bone, and sometimes to tendons and joints. And during debridement of a foot ulcer, the wound is probed with a metal instrument to see how deep it is.

This page doesn’t give a list of bone infection symptoms to check yourself against.

What applies is the general rule: a wound that is not healing needs the reason found. Determining why it is not healing is one of the four things a wound care team does. A wound is called non-healing if it has not started to heal in 2 weeks or has not completely healed in 6 weeks.

What to watch for

Contact your provider right away if you have symptoms of cellulitis, and right away again if you are being treated and develop persistent fever, drowsiness, lethargy, blistering, or red streaks that spread.

Bone infection is one of the complications that may follow if cellulitis is not treated or treatment does not work.

A non-healing wound is one that has not started to heal in 2 weeks or has not completely healed in 6 weeks. Chronic bone infection is one of the causes of non-healing foot ulcers.

This page doesn’t give symptoms you could use to recognize bone infection yourself. A wound that is not healing is the finding to act on.

Wound Wizard is general education and can’t assess your wound. Your own clinician is the right person to ask.

What we look at

  • Examining and probing the wound for depth
  • Determining why the wound is not healing
  • Investigating for infection, including of the bone
  • Creating a treatment plan

Sources

  1. Cellulitis — MedlinePlus, U.S. National Library of Medicine https://medlineplus.gov/ency/article/000855.htm
  2. Wound care centers — MedlinePlus, U.S. National Library of Medicine https://medlineplus.gov/ency/patientinstructions/000739.htm
  3. How to care for pressure sores — MedlinePlus, U.S. National Library of Medicine https://www.medlineplus.gov/ency/patientinstructions/000740.htm
  4. Negative Pressure Wound Therapy — StatPearls, National Library of Medicine https://www.ncbi.nlm.nih.gov/books/NBK576388/