Page 1 of 1: ortho - acute osteomyelitis

sids_82 · Credits: 1973 My Scrapbook

What is the commonest site of Acute Osteomyelitis in infants :-

a) Hip Joint

b) Tibia

c) Femur

d) Radius

guest · Credits: 78845 My Scrapbook My Reading List 262569 Books

The annual incidence of acute osteomyelitis is about 1/5000 children under 13 years old. This disease appears to affect males more often than females, and the majority of the cases occur in patients less than 20 years old. The most common cause of osteomyelitis is bacterial; however, fungal and viral causes are also possible.

Acute bacterial osteomyelitis can be thought of in three different categories: 1) hematogenous seeding, 2) contiguous spread, and 3) direct inoculation of the bone either from surgery or trauma. Of the three categories, acute hematogenous osteomyelitis is the most common presentation in children. Acute hematogenous osteomyelitis has a predilection for the long bones of the body. Long bones consist of two distinct types of bone. The diaphysis or shaft is made of a dense lamellar bone, which is relatively acellular and slow growing. The ends of the bone near the growth plate (the metaphysis) is made of a maze like bone called cancellous bone. This maze like structure allows for spreading of the infection via small channels in the bone that leads into the subperiosteal space. It is here in the rapidly growing metaphysis that osteomyelitis often develops. The process begins when thrombosis and bacterial emboli transmigrate through the end capillaries as a result of local trauma or stasis of local blood flow. This results in bacterial seeding creating a nidus for infection that can be difficult to remove due to a relative lack of reticuloendothelial cells. Pus collects in the subperiosteal space and surrounding edema produces a mass effect that further decreases blood flow perpetuating tissue ischemia and necrosis. Isolated pieces of dead bone, or sequestrations can result from this process. As the remodeling process continues, an involucrum can be created when new bone is deposited over an area of dead bone. The pathophysiology of osteomyelitis differs slightly by age group. In neonates, blood flow from the metaphysis is continuous with the joint space and thus a concurrent septic arthritis may develop. Furthermore, in this age group the periosteum is thinner and thus more likely to rupture into surrounding tissue. This is in contrast to older children in which the infection is contained due to a well developed periosteum resulting in focal physical findings.

The signs and symptoms of acute osteomyelitis may be subtle, especially in the very young. The chief complaint of a child suspected of having osteomyelitis may be refusal to walk and bare weight on the affected limb, or the refusal to utilize a specific body part. Often a recent history of upper respiratory symptoms or trauma is elicited. The very young infant may present with only a history of a poor appetite and fever, or be ill appearing in fulminate septic shock. Objective findings are fever, swelling, point tenderness, and erythema of the affected body part. The child may have a pseudoparalysis of the affected limb. The most common long bones involved in descending order are the femur, tibia, humerus, fibula, radius and ulna. Flat bones are affected less than 20% of the time; of these the calcaneus and pelvic bones are the most common and about equal in incidence . (Krogstad P, Smith A. Chapter 64: Osteomyelitis and Septic Arthritis. In: Feigin RD, Cherry JD (eds). Textbook of Pediatric Infectious Disease, 4th edition. 1998, Philadelphia: W.B. Saunders Co., pp. 683-698)

sids_82 · Credits: 1973 My Scrapbook

Thanks mate! And nice reference too!!

suneet · Credits: 6840 My Scrapbook

so ans is hip jt

taru · Credits: 357 My Scrapbook

practically also most cases of osteomyelitis in children present with septic arthritis around the hip joint.....so seeing is believing??

wondergirl · Credits: 13277 My Scrapbook

commonest site for acute osteomyelitis is distal end of femur!

suneet · Credits: 6840 My Scrapbook

any ref wondergirl

wondergirl · Credits: 13277 My Scrapbook

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