II. Epidemiology
- More common in boys
III. Pathophysiology
- Inflammatory bone changes associated with pathogenic Bacteria (often monomicrobial)
- Staphylococcus aureus is most common cause in Pediatric Osteomyelitis
- Typically acute hematogenous spread to Traumatized bone
- Most common in children under age 5 (50% of cases)
- Most commonly affects the highly vascular metaphyses of long bone
IV. Symptoms
- Presentation within two weeks of symptom onset
- Fever
- Irritability or lethargy
V. Signs
- Systemic signs of infection
- Local signs of infection
- Tenderness on palpation over involved bone
- Localized inflammation with erythema and swelling
- Decreased range of motion of adjacent joints
- Distribution
- Femur, tibia or fibula
- Account for 50% of Osteomyelitis cases in prepubertal children
- May present with Pediatric Limp
- Vertebral Osteomyelitis
- Most common form of hematogenous Osteomyelitis, especially in older children or adults
- Presents with severe neck or back pain, Muscle tenderness and reduced range of motion
- Other sites
- Sternoclavicular Bone
- Pelvic Bone
- Other long bones
- Femur, tibia or fibula
VI. Causes
VII. Differential Diagnosis
- See Osteomyelitis
VIII. Labs
- See Osteomyelitis
- ESR and CRP may be early indicators of Osteomyelitis (albeit non-specific)
IX. Imaging
- See Osteomyelitis
- XRays are often normal for first 2-3 weeks
X. Diagnosis
- See Osteomyelitis
XI. Management
XII. References
- Jhun and Raam in Herbert (2016) EM:Rap 16(2):15-6
- Hatzenbuehler (2011) Am Fam Physician 84(9): 1027-33 [PubMed]
- Boutin (1998) Orthop Clin North Am 29:41-66 [PubMed]
- Bury (2021) Am Fam Physician 104(4): 395-402 [PubMed]
- Carek (2001) Am Fam Physician 63(12):2413-20 [PubMed]
- Dirschl (1993) Drugs 45:29-43 [PubMed]
- Eckman (1995) JAMA 273:712-20 [PubMed]
- Haas (1996) Am J Med 101:550-61 [PubMed]
- Lew (1997) N Engl J Med 336:999-1007 [PubMed]
- Lipsky (1997) Clin Infect Dis 25:1318-26 [PubMed]