- general features:
- pediatric bone circulation
- age of patient:
- osteomyelitis in the newborn
- in infants below the ages of 1 year, some metaphyseal vessels may transverse epiphyseal plate and permit spread of infection to epiphysis and adjacent joint;
- this is most common in the hip, and occurs less often in the shoulder, and rarely in the elbow;
- osteomyelitis in the child
- bones of children are enveloped in a tough periosteal sleeve;
- this sleeve is lifted away from the bone by dissecting pus;
- periosteal sleeve is firmly attached to the bone in the region of epiphyseal plate and forms a barrier to prevent spread of infection to the adjacent joint;
- most common organism is staphylococcus aureus;
- streptococcal & haemophilus influenzae bone infections are seen in young children, and sickle cell patients are prone to bone infection by salmonella;
- in older adults and in patients with compromised immune systems, bone infection by gram-negative organisms is common;
- tubercle bacilli and fungi may also cause hematogenous osteomyelitis;
- ref: Microbiological culture methods for pediatric musculoskeletal infection: a guideline for optimal use.
- diff dx:
- leukemia and EOG
- associated conditions:
- septic arthritis
- occurs most often in young children (12 to 18 months) due to the epiphyseal circulation;
- in older children, associatted septic arthritis can occur w/ involvement of the proximal femur (most common), and less often in
the proximal humerus, distal lateral tibia, and the radial head;
- multiple sites of involvement:
- in neonates with hematogenous osteomyelitis, 40% will have multiple sites of involvement;
- Clincial Findings:
- high fever and WBC are variable findings;
- metaphyseal tenderness is often present (joint motion should be unhindered unless septic arthritis is present);
- bone aspiration is performed at site of maximal tenderness using a 16 or 18 gauge spinal needle;
- Radiographic Findings
- radiological features can mimic various benign or malignant bone tumours and non-pyogenic infections;
- Radioisotope Scanning
- useful for identifying multiple sites of involvement (neonates);
- Surgical Debridement:
- some argue that surgical debridement is indicated if pus is aspirated;
- surgical drainage is effected by opening the periosteum and cortical drilling;
- Subacute Haematogenous Osteomyelitis:
- may be an uncommon cause of limp in children;
- dx can be difficult since signs, symptoms, and labs for osteomyelitis are often unremarkable;
- look for sublte extremity swelling and/or subtle loss of range of motion;
- elevated temperature is uncommon;
- radiographs may show a well circumscribed subchondral lesion w/ well defined trabecular margins;
- bone scan is often positive;
- treatment often consists of surgical evacuation both as a therapeutic measure and a diagnostic measure (in order to rule out malignancy);
- in the report by Rascol MN (2001), the author followed 21 children (1990-1998) with primary subacute haematogenous osteomyelitis;
- pain, swelling and a limp had been present for two to 12 weeks with little functional impairment;
- laboratory tests were non-contributory;
- lesions were classified radiologically into metaphyseal, diaphyseal, epiphyseal and vertebral;
- 24 sites involved, with most (20) being in the tibia; 17 lesions were in the diaphysis, 5 in the metaphysis and two in the epiphysis;
- diagnosis was confirmed histologically in all cases;
- staphylococcus aureus was cultured in six patients;
- healing occurred in all patients after treatment with antibiotics for 6 weeks and radiological improvement was seen after three to six months;
- subacute osteomyelitis develops as a result of increased host resistance and decreased bacterial virulence;
- histological confirmation is necessary to avoid a delay in diagnosis;
- Primary subacute haematogenous osteomyelitis of the tarsal bones in children.
- Subacute osteomyelitis presenting as bone tumors.
- Primary subacute haematogenous osteomyelitis in children.
Acute and chronic osteomyelitis in children. Ferguson AB: Clin Orthop 1973;96:51.
Acute osteomyelitis in children: a review of 116 cases.
Pediatric Acute Hematogenous Osteomyelitis
The treatment of chronic hematogenous osteomyelitis.
Primary subacute epiphyseal and metaepiphyseal osteomyelitis in children. diagnosis and treatment guided by MRI.
Haematogenous acute and subacute paediatric osteomyelitis: a systematic review of the literature.
Original Text by Clifford R. Wheeless, III, MD.
Last updated by Data Trace Staff on Thursday, August 20, 2015 9:54 am