II. Epidemiology

  1. More common in boys

III. Pathophysiology

  1. Inflammatory bone changes associated with pathogenic Bacteria (often monomicrobial)
    1. Staphylococcus aureus is most common cause in Pediatric Osteomyelitis
  2. Typically acute hematogenous spread to Traumatized bone
    1. Most common in children under age 5 (50% of cases)
    2. Most commonly affects the highly vascular metaphyses of long bone

IV. Symptoms

  1. Presentation within two weeks of symptom onset
  2. Fever
  3. Irritability or lethargy

V. Signs

  1. Systemic signs of infection
  2. Local signs of infection
    1. Tenderness on palpation over involved bone
    2. Localized inflammation with erythema and swelling
    3. Decreased range of motion of adjacent joints
  3. Distribution
    1. Femur, tibia or fibula
      1. Account for 50% of Osteomyelitis cases in prepubertal children
      2. May present with Pediatric Limp
    2. Vertebral Osteomyelitis
      1. Most common form of hematogenous Osteomyelitis, especially in older children or adults
      2. Presents with severe neck or back pain, Muscle tenderness and reduced range of motion
    3. Other sites
      1. Sternoclavicular Bone
      2. Pelvic Bone
      3. Other long bones

VI. Causes

VII. Differential Diagnosis

VIII. Labs

  1. See Osteomyelitis
  2. ESR and CRP may be early indicators of Osteomyelitis (albeit non-specific)

IX. Imaging

  1. See Osteomyelitis
  2. XRays are often normal for first 2-3 weeks

X. Diagnosis

XI. Management

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