- Pathogenesis:
- occurs most frequently in the long bones of lower extremities, & to a lesser extent the upper extremities;
-
hematogenous osteomyelitis:
-
pediatric bone circulation: tortuous course of
nutrient vessels in bone causes bacteria to be trapped in the metaphysis;
-
epiphyseal plate prevents infection from entering the joint space in older children but not in
neonates;
-
joint infection secondary to osteomyelitis may occur in shoulder, radial head and the
hip as a result of synovial
membrane inserting distally to epiphysis, allowing bacteria to spread directly from the metaphysis to the joint space;
- infecting organism may reach the joint in three ways:
- hematogenous seeding of synovial membrane
- extension from an adjacent focus of osteomyelitis
- direct implantation from a penetrating wound;
- bacteriology:
-
ages 6 mo to 2 yrs
-
ages over 2 yrs
- predisposing conditions:
- chicken pox: streptococcus
- ear infection: h. influenza or streptococcus;
- sickle cell: salmonella;
- meningitis:
- Work Up:
- aspiration of site:
- in order to recover causitive organisms & to determine whether an abscess is present, which wound require surgical drainage;
- drilling is used to decompress known proximal femoral osteomyelitis that has not already decompressed into the hip joint and to obtain a Gram's stain and culture
material in cases of possible primary bone infection with sympathetic hip effusions;
- in 1974, Kemp and Lloyd-Roberts noted several cases of osteonecrosis after proximal femoral osteomyelitis w/o apparent hip sepsis;
- based on this, they recommended drilling all proximal femoral osteomyelitis;
- Treatment:
-
antibiotics:
-
criteria for oral ATB's
Treatment of chronic osteomyelitis in children resistant to previous therapy.
Deep Venous Thrombosis Associated with Osteomyelitis in Children
