What should you know about emphysematous osteomyelitis?

Osteomyelitis means infection involving bone. The emphysematous form is identified when gas is seen within bone or adjacent soft tissue on imaging. Gas can be produced by certain bacteria, enter from nearby infected tissue, or appear after a procedure or injury, so imaging must be interpreted with the clinical history. Pain, swelling, warmth, fever, chills, reduced movement, or feeling very unwell may occur, although symptoms vary by the bone involved and the person’s health.

This condition can affect the spine, pelvis, or a limb and may be associated with infection elsewhere. Diabetes, reduced immunity, circulation problems, recent surgery, or an open wound can influence risk and treatment decisions, but the diagnosis depends on examination and investigations.

Contact urgent medical services if this diagnosis is suspected or reported on a scan. Hospital care may include blood tests, cultures, detailed imaging, and antibiotics selected for the likely organism and adjusted when results are available. Surgeons may need to drain infected material, remove unhealthy tissue, or stabilise affected bone. [Bone Grafting](/treatments/trauma-and-fracture-care/bone-grafting/) may be considered later when infection control has left a bone defect; it is not a substitute for treating active infection. Do not squeeze a wound or delay assessment while waiting for symptoms to settle.

Seek emergency help for fever with confusion, fainting, rapid breathing, severe or rapidly increasing pain, new weakness, inability to use a limb, or drainage from a wound with a worsening general illness. A person with a suspected spinal infection should seek urgent care for new leg weakness, numbness around the groin, or difficulty controlling urine or stool.

Where is the infection located, and was gas seen inside bone or in nearby tissue? Which samples will identify the organism? Will I need drainage or removal of infected bone? How will treatment be monitored, and what symptoms should prompt immediate review?