A regional approach to osteomyelitis of the lower extremities in children

Modem cross-sectional imaging, particularly MRI, has revolutionized the diagnosis and management of osteomyelitis in childhood. Diagnoses are made sooner, with greater confidence, and with better characterization of the extent of disease than possible on plain film grounds. Because the infection begins within the juxtaphyseal medullary bone, the MRI features are distinctive and frequently diagnostic of infection. Plain radiography continues to be an essential first step in the evaluation of suspected osteomyelitis and may on occasion be the only imaging study required for diagnosis and treatment. An understanding of the fundamental pathophysiology of osteomyelitis in the growing skeleton, in conjunction with the application of newer diagnostic imaging techniques, should continue to reduce the morbidity from this common pediatric problem.