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Hematogenous calcaneal osteomyelitis in children
1Department of Orthopaedics, Atlanta Medical Center, Georgia 30312, USA. juhajaakkola@yahoo.com
Journal of Pediatric Orthopedics
|November 26, 1999
Summary
Hematogenous osteomyelitis in children primarily affects the calcaneus, presenting with swelling and tenderness. While Staphylococcus aureus is common, imaging like scintigraphy is highly sensitive for diagnosis.
Area of Science:
- Pediatric Orthopedics
- Infectious Diseases
- Radiology
Background:
- Hematogenous osteomyelitis is a serious bone infection that can occur in children.
- The calcaneus (heel bone) is a potential site for this infection in skeletally immature patients.
- Understanding the clinical presentation, diagnostic markers, and treatment outcomes is crucial for effective management.
Purpose of the Study:
- To review cases of hematogenous osteomyelitis specifically affecting the calcaneus in young patients.
- To analyze the clinical and radiographic findings, laboratory results, and microbiological data.
- To evaluate the effectiveness of different treatment modalities and their impact on patient outcomes.
Main Methods:
- Retrospective review of 21 skeletally immature patients diagnosed with hematogenous osteomyelitis of the calcaneus.
- Analysis of patient demographics, clinical signs (tenderness, swelling, erythema), laboratory markers (ESR, CRP), and culture results.
- Evaluation of diagnostic imaging including plain radiographs and bone scintigraphy; assessment of treatment strategies (antibiotics alone vs. surgery plus antibiotics) and follow-up data.
Main Results:
- The average patient age was 2.9 years, with common symptoms including local tenderness, swelling, and erythema.
- Elevated erythrocyte sedimentation rate (ESR) was observed in 95% of patients, while C-reactive protein (CRP) was abnormal in 47%.
- Staphylococcus aureus was the most frequent pathogen identified. Plain films showed lytic lesions in 71%, and scintigraphy was positive in 100% of scanned cases. Both antibiotic therapy and surgical intervention with antibiotics were employed, with residual radiographic abnormalities noted in some patients post-treatment.
Conclusions:
- Hematogenous osteomyelitis of the calcaneus in children presents with characteristic clinical signs and elevated ESR.
- Scintigraphy demonstrates high sensitivity for diagnosis, while plain films may show lytic lesions.
- Both conservative and surgical management approaches can be effective, though residual radiographic changes may persist.