Podcast
Questions and Answers
What is the usual cause of inflammation of bone?
What is the usual cause of inflammation of bone?
What percentage of hematogenous osteomyelitis cases occur in children under 5 years old?
What percentage of hematogenous osteomyelitis cases occur in children under 5 years old?
Which bones are more likely to be affected in osteomyelitis?
Which bones are more likely to be affected in osteomyelitis?
What is the mode of spread of infection in osteomyelitis?
What is the mode of spread of infection in osteomyelitis?
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What is the result of the generation of proteolytic enzymes and cytokines in osteomyelitis?
What is the result of the generation of proteolytic enzymes and cytokines in osteomyelitis?
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What is a common clinical feature of osteomyelitis in children?
What is a common clinical feature of osteomyelitis in children?
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Why is a past medical history of sickle cell disease relevant in osteomyelitis diagnosis?
Why is a past medical history of sickle cell disease relevant in osteomyelitis diagnosis?
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What is the result of purulence beneath the periosteum in osteomyelitis?
What is the result of purulence beneath the periosteum in osteomyelitis?
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What is a common finding during examination of a patient with osteomyelitis?
What is a common finding during examination of a patient with osteomyelitis?
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What is the gold standard in diagnosing early osteomyelitis?
What is the gold standard in diagnosing early osteomyelitis?
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What is the primary use of technetium radionuclide bone scan in osteomyelitis?
What is the primary use of technetium radionuclide bone scan in osteomyelitis?
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What is the primary goal of surgical treatment in osteomyelitis?
What is the primary goal of surgical treatment in osteomyelitis?
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What is a possible complication of osteomyelitis?
What is a possible complication of osteomyelitis?
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What is the typical radiologic finding in chronic osteomyelitis?
What is the typical radiologic finding in chronic osteomyelitis?
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What is the recurrence rate of osteomyelitis?
What is the recurrence rate of osteomyelitis?
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What is the primary treatment option for chronic osteomyelitis?
What is the primary treatment option for chronic osteomyelitis?
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Study Notes
Osteomyelitis
- Inflammation of bone usually results from bacterial infection.
- Early recognition and diagnosis are crucial.
- 50% of cases occur in children less than 5 years old.
- No racial differences, but males are twice as likely to be affected as females.
- Long bones of the lower extremities are more likely affected.
Aetiology of Osteomyelitis
- Hematogenous dissemination of bacteria to bones, especially in growing bones with rich vascular supply.
- Organisms deposited in metaphyseal capillaries replicate and spread to cortical bone.
- Osteomyelitis may also occur from contiguous spread of infection after trauma or bite wounds.
Pathophysiology
- Bacterial focus establishment leads to phagocyte migration, inflammatory exudate (metaphyseal abscess), and tissue destruction.
- Pressure increases, spreading through the porous metaphyseal space to the subperiosteal space.
- Purulence beneath the periosteum may lift the periosteal membrane, impairing blood supply to the cortex and metaphysis.
Clinical Features
- Long bones (femur, tibia, humerus) are most commonly affected.
- Symptoms include fever, malaise, bone pain, swelling, redness, and pseudoparalysis.
- Children may refuse to bear weight, walk, or move the affected extremity.
- Asymmetric movement of extremities and past medical history of underlying conditions (e.g., sickle cell disease or immunodeficiency) are relevant.
Examination Findings
- Patients may look ill and febrile.
- Edema, erythema, and warmth are evident over the affected portion of bone.
- Palpation of the bone reveals a focal site of maximum tenderness.
- Normal range of movement of the affected limb is usually preserved.
Diagnosis
- Radiologic:
- Radiography: initial films may be normal, with or without soft tissue swelling; bone destruction occurs in 10-15 days.
- MRI: gold standard in early infections, shows increased marrow intensity with surrounding inflammation.
- Technetium radionuclide bone scan: reveals increased osteoblastic activity of the infected bone.
- Laboratory investigations:
- Blood culture
- Bone aspirate for m/c/s
- FBC
- C-reactive protein
- ESR
Treatment
- Medical:
- Therapy considerations: age, local resistance pattern, suspected pathogens
- Empiric treatment: anti-staph agents (e.g., vancomycin), 3rd generation cephalosporin; duration: 3-6 weeks
- Surgical: debridement may be needed
Complications
- Chronic osteomyelitis
- Venous thrombosis
- Bone necrosis
- Pathologic fractures
- Disturbance in bone growth
- Abnormal gait
- Limb shortening
- Arthritis
Differential Diagnosis
- Cellulitis
- Pyomyositis
- ALL
- Subcutaneous abscess
- Fractures
- Septic arthritis
- Bone tumour (osteosarcoma, Ewing sarcoma)
- Poliomyelitis
- Child abuse
- Trauma
Prognosis
- Re-occurrence in 5-10% of cases
Chronic Osteomyelitis
- Typical radiologic findings: Sequestrum and involucrum
- Treatment: surgical removal of sinus tracts and sequestrum, if present
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Description
Learn about the inflammation of bone, its causes, and symptoms in children. This quiz covers the epidemiology and aetiology of osteomyelitis, a crucial paediatrics topic.
