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Acute
Management
In Children
No Local Resistance
Coagulase + Staph
Because of this anatomic factor,
what bones are most commonly
affected ?
The bones with the largest
growth centers:
Femur, Tibia, Humerus
60-70%
Calcaneus ,Fibula ,Radius
5-10 %
What is the role of trauma
in the etiology of osteomyelitis?
Plain X-Rays
Ultrasound
Radio nucleotide
Scans
C-T Scans
MRI
What are the classic findings on the
plain X-rays?
What
What isWhat
the is this
is this
clinical area of
significance
ofarea ofradiographic
dead bone
periosteal
these newtermed?
bone
changes?
termed?
Seqestrum Involucrum
Too Late
Indicates Dead Bone !
What are the early bony X-ray signs?
Periosteal new bone formation?
What does
Tell me thisyou
Agree
what ?indicate
see ? ?
1st Stage:
usually indicates the pus
is still within the bone
What does the 2nd stage
Sub-Periosteal indicate?
Pus
Sub-Periosteal Pus
What is a good non-invasive
Ultrason way to
better define subperiosteal fluid?
No Significant Changes
Ultrasound detects
subperiosteal fluid
Day One Day Two
Fever Continued
What is the role of the
technetium scan?
What does this examination tell you?
MRI
What specifically does it reveal?
Demonstrates both soft and bony
changes
Changes appear early
Remember changes demonstrate
only increased water in the
tissues!!!
WhereFor
is itspinal lesionsuseful ?
especially
Disc space infections
Bone Scan: ill defined Definite on M R I
MRI:
Also better defines extremity lesions
Scan: Poor Definition MRI: Better
Definition
Can imaging diagnose osteomyelitis ?
Not completely,
Imaging only tells where the pathology is !!
Oral antibiotics
are now the mainstay
RECENT TRENDS IN
OSTEOMYELITIS THERAPY
Use of C-reactive protein to diagnose
skeletal infection and monitor therapy
Permanent defect
develops
Local pus
remained
for two weeks
Need to debride all the dead
bone within the intramedullary cavity
2 Mo
Later
Unusual Locations
Clinically,
resists flexion
Disc Space Infections
Early: what are the x-
ray changes ?
None
Late: what are the
x-ray changes ?
Narrowing and sclerosis
What special type does this
represent?
Sub-Acute
Low Grade
Symptoms
Often Prior
Antibiotics
Treatment:
Aspiration plus
antibiotics
May require
surgical drainage
Diaphyseal osteomyelitis
What type of bone tumors do we have here?
(simulating tumors)
Osteogenic Sarcoma ? Ewings Sarcoma ?
Thank you
for your attention