Acute epiphyseal osteomyelitis in children

Area of Science:

• Pediatric Orthopedics
• Pediatric Infectious Diseases
• Skeletal Radiology

Background:

• Acute osteomyelitis typically affects the metaphysis of long bones in children.
• Epiphyseal involvement in pediatric osteomyelitis is less commonly recognized but can occur.

Purpose of the Study:

• To describe the clinical presentation, imaging findings, and diagnostic considerations of acute osteomyelitis originating in the epiphysis of long bones in children.
• To highlight the epiphysis as a potential site for hematogenous osteomyelitis.

Main Methods:

• Retrospective review of nine children diagnosed with acute epiphyseal osteomyelitis.
• Analysis of clinical data, erythrocyte sedimentation rate (ESR), plain radiographs, and bone scintigraphy findings.

Main Results:

• Seven of nine patients had lesions limited to the epiphysis, with the distal femur being the most common site (seven cases).
• All patients presented with pain at the infected site and elevated ESR.
• Bone scintigraphy accurately identified infected sites in all performed cases and enabled early diagnosis in four.
• Radiographs revealed epiphyseal lytic lesions consistent with scintigraphic findings.

Conclusions:

• The epiphysis of a long bone should be considered a potential site for hematogenous osteomyelitis in children.
• Understanding the unique vascular anatomy of the epiphysis aids in recognizing this pattern of infection.
• Early diagnosis and appropriate management are crucial for favorable outcomes in pediatric epiphyseal osteomyelitis.