- osteomyelitis 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 metaphysis to 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;
- ages 6 mo to 2 yrs
- ages over 2 yrs
- predisposing conditions:
- chicken pox: streptococcus
- ear infection: h. influenza or streptococcus;
- sickle cell: salmonella;
- references: The changing epidemiology of osteomyelitis in children.
- Work Up:
- before aspiration, consider whether an MRI is indicated (you do not want to aspirate and EOG without a prestage MRI);
- 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;
- reference: Avascular necrosis of the capital epiphysis following osteomyelitis of the proximal femoral metaphysis
- surgical debridement and vancomycin Ca sulfate
- Treatment of chronic osteomyelitis in children resistant to previous therapy.
- deep venous thrombosis
- Deep Venous Thrombosis Associated with Osteomyelitis in Children
- Upper-Extremity Deep Venous Thrombosis Associated with Proximal Humeral Osteomyelitis in a Child. A Case Report
- Deep venous thrombosis associated with acute hematogenous osteomyelitis in children.
- Venous thrombosis and thromboembolism in children with osteomyelitis.
Pediatric Humeral Osteomyelitis
Osteomyelitis in infants and children. A review of 163 cases.
Primary subacute epiphyseal osteomyelitis.
Diaphyseal primary subacute osteomyelitis in children.
Osteomyelitis of the calcaneus in children.
Occult epiphyseal bone abscess: lessons for the unwary.
Hematogenous osteomyelitis of the wrist in children.
Osteomyelitis of the pelvis in children.
The three syndromes of iliac osteomyelitis in children.
Chronic Osteomyelitis in Children: Treatment by Intramedullary Reaming and Antibiotic-impregnated Cement Rods
Pathologic Fractures in Children with Acute Staphylococcus aureus Osteomyelitis