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Transphyseal involvement of pyogenic osteomyelitis is considerably more common than classically taught
Dorothy Gilbertson-Dahdal1, Jason E Wright, Elizabeth Krupinski
11 Department of Medical Imaging, University of Arizona, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5067.
Objective:
Radiologists are taught that pyogenic osteomyelitis in children rarely crosses the growth plate because terminal vessels of nutrient arteries loop at the physis, predisposing the metaphysis to hematogenous infection. However, we note that MRI frequently shows osteomyelitis involving both sides of the physis. The purpose of this article is to document our observation that pyogenic osteomyelitis crosses the growth plate more frequently in the pediatric patient population than is classically taught.
Materials And Methods:
All pediatric patients (age, 2-16 years) with clinically suspected osteomyelitis from 2004 to 2009 were reviewed for transphyseal disease on a consensus basis. To reveal the statistical significance, we applied a z test to our results. We quantified rare as 20% or less and used a z test to determine whether 27 of 32 (81%) differed from rare.
Results:
Of 32 subjects, 81% showed transphyseal infection. In our study, the z test revealed that transphyseal infection occurred significantly more often than what would be considered rare (z = 4.75, p < 0.01).
Conclusion:
In our pediatric patient population, we have documented a higher frequency of transphyseal osteomyelitis (81%) than metaphyseal osteomyelitis in pyogenic infections. When our findings are statistically compared with an expected rate of 20%, they cannot be attributed to chance alone. This raises some doubt regarding the conventional understanding of pediatric pyogenic osteomyelitis.
Insights
Pyogenic osteomyelitis in children frequently crosses the growth plate, challenging traditional teaching. This study found 81% of pediatric cases involved transphyseal infection, a significantly higher rate than previously assumed.
Area of Science:
- Pediatric Radiology
- Pediatric Orthopedics
- Infectious Diseases
Background:
- Classical teaching states pyogenic osteomyelitis in children rarely crosses the growth plate due to metaphyseal terminal vessel looping.
- Magnetic Resonance Imaging (MRI) findings suggest osteomyelitis frequently involves both sides of the growth plate in pediatric patients.
Purpose of the Study:
- To document the frequency of pyogenic osteomyelitis crossing the growth plate in pediatric patients.
- To challenge the conventional understanding of pediatric pyogenic osteomyelitis based on observed imaging data.
Main Methods:
- Retrospective review of pediatric patients (ages 2-16) with suspected osteomyelitis from 2004-2009.
- Consensus review to identify transphyseal disease on MRI.
- Statistical analysis using a z test to compare observed frequency with a predefined 'rare' threshold (≤20%).
Main Results:
- Transphyseal infection was observed in 81% (27 of 32) of pediatric subjects.
- The z test confirmed that this high rate of transphyseal infection (81%) was statistically significant (z = 4.75, p < 0.01) compared to a rare occurrence (≤20%).
Conclusions:
- Pyogenic osteomyelitis crosses the growth plate in a significantly higher percentage of pediatric patients (81%) than traditionally taught.
- These findings raise questions about the established understanding of pediatric hematogenous osteomyelitis spread.
- The high frequency of transphyseal involvement suggests a need to re-evaluate current radiological and clinical paradigms.
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