Author Question: Bone Infection after Orthopedic Surgery

Sarah Asks:

My character was assaulted and, among other injuries, her right forearm was fractured severely. It was surgically repaired using pins.

My question is: Is it possible for her to develop osteomyelitis after a blunt-force trauma (that does not result in a fracture) two years after the original injury? If not, is there another scenario that could cause osteomyelitis after the fact like that? And what would be the immediate treatment plan following the second injury and osteomyelitis? Also, if left untreated for a period of time, could osteomyelitis become life-threatening?

Jordyn Says:

The first part of your question does not seem plausible to me. First, you imply that there isn’t a fracture associated with the second injury to this arm and the length of time doesn’t quite work. The arm should be fully healed two years post surgery to repair the fracture.

If this character were to develop osteomyelitis near the site where she received a blow by a blunt object, but that arm had been previously fractured two years prior, I don’t see the medical staff thinking these two things are related. They are just too far apart.

I don’t know of another scenario that could cause this to happen two years out– that the blunt force blow (that doesn’t break the skin or cause fracture) somehow ignites an osteomyelitis at a previous surgical site. If it did, I think it would be considered happenstance.

Ostemyelitis generally happens when bacteria gets to the bone through an open wound (open fractures are a great way to write this complication) or the infection to the bone is seeded from another area in or on the body (a septic joint for instance). The infection will generally develop within two weeks.  Even in the article linked in this paragraph, chronic osteomyelitis usually develops within two months. Nothing even close to two years.

The course of treatment for osteomyelitis would depend on what bacteria (or fungus) is causing the infection. Surgery could also be indicated.

Yes, any infection can become life threatening particularly if the bacteria or fungus gets into the bloodstream.

Hope this helps and good luck with this story!

Author Question: Does Blood Loss Effect Fever?

Fraidy Asks:

I was wondering how blood loss would effect a fever? The character is ill with strep throat (or a stomach bug) and a fever that makes her want to cover up under layers of warmth. This is before an accident involving shattered glass and deep cuts and moderately serious blood loss. Would her fever be brought down due to the blood loss or would it complicate things more?

Jordyn Says:

Hi Fraidy! Thanks so much for sending me your question.

In your question, you don’t specify whether or not the patient/character has received treatment for the cause of her fever. In the case of strep throat, they should have been prescribed an antibiotic, and should be feeling markedly better in 24-72 hours. There can still be fever, but it should not be as high as the days go on if the antibiotic is working against the bacteria that is growing.

If this accident occurred say after three days, I would imagine she should be fever free by that time.

However, let’s say the character was just diagnosed and still has increased fever related to the illness.

I would theorize that a high fever, 102 degrees and higher, could cause your character to have some exacerbated symptoms related to additional blood loss. A high fever will naturally increase a patient’s heart rate— and so does blood loss. There could also be a concern that an untreated infection could cause the patient to go into septic shock, of which one complication of sepsis is lowered blood pressure. Low blood pressure is also a symptom of blood loss— if the patient bleeds out enough.

The combination of these two things, low blood pressure and increased heart rate, in light of a patient with a high fever and blood loss can paint a complicated picture for the medical team. They may not know which (blood loss or infection) is making their patient so sick so they would take a dual approach to their treatment which could entail the following.

1. Drawing labs that look at blood counts, blood chemistries, but also those that would address sepsis concerns like blood cultures. Also type and cross for blood. Initially, for symptoms of low blood pressure and tachycardia, the patient will usually receive fluid boluses of normal saline IV.

If the patient is really hypotensive (low blood pressure) and tachycardic (increased heart rate) and is not improved from the IV fluid, the medical team might choose to give O negative blood instead of waiting for a formal type and cross to come back. If the patient is actively bleeding and the bleeding is hard to control, they could opt to start giving blood right away.

2. Consider antibiotics early in the course of treatment once any body fluids are cultured the provider thinks necessary to determine the source of infection. It is helpful if a family member could offer insight into what infection the patient might have or the symptoms they were experiencing before the accident.

3. If the blood pressure remains low despite fluid boluses IV and perhaps blood, then patients are generally placed on a vasopressor which is a class of medications given as a continuous infusion IV to help raise blood pressure.

4. Treat the fever with a fever reducing medicine like acetaminophen or ibuprofen. If the patient is headed to surgery to treat wounds from the car accident, then acetaminophen (or Tylenol) might be preferred.

Hope this helps and best of luck with your story!

Author Question: Stab Wound to the Lower Abdomen

Katerina Asks:

My character, Faith, is stabbed with a switch blade (about  8.5 cm long)  in the lower abdomen. I have three questions about this.

1. Can she die from this and how long would it take?
2. Would she have to go to the hospital?
3. If she survives will there be any permanent or semi  permanent  damage?

Jordyn Says:

Hi Katerina! Thanks so much for sending me your question.

You don’t give specifics on exactly where in the lower abdomen your character gets stabbed (left, right, or mid line). If stabbed in the lower abdomen, there are fewer things that can be hit that will cause you to die immediately— generally from blood loss. Though there is that descending aorta to worry about.

The lower abdomen mostly contains intestines, the bladder, and reproductive organs for the female. A person can die from injury to these body parts– most likely from infection leading to septic shock. This would be unlikely should your character receive medical care shortly after the injury.

If you choose to go this route, I would say death from sepsis could be as early as 48-72 hours to as long as a few weeks. On the early side if the character did not receive any medical treatment and there are some nasty germs either on the knife or the intestines are punctured leading to contamination of the abdominal cavity and no surgical repair or antibiotics are given.

Longer if there is surgery and antibiotic therapy but the person is infected with a resistant strain of a bacteria or fungus, or is immunocompromised, etc.

A stab wound of this type should be evaluated in the hospital. Again, this would be up to you as the author and what kind of conflict you want to have for your story.

It’s hard to say if this character would have any lasting effects from the wound as you don’t give specifics as to the injury.

Best of luck with your story.