Osteomyelitis

Question 1

What is osteomyelitis?

Answer 1

Infection of metaphysis of long bones (wide portion of long bone, between epiphysis and diaphysis)

Question 2

Where are the commonest sites for osteomyelitis to be found?

Answer 2

Distal femur/proximal tibia.

any bone may be affected

Question 3

How does infection come about in osteomyelitis?

Answer 3

Usually due to haematogenous spread, but may arise from direct spread from infected wound.

Question 4

What are the commonest causative organisms of osteomyelitis?

Answer 4

Staphylococcus aureus (most common)

Strep and h. influenzae (if not immunised) also involved.

Question 5

How does osteomyelitis present? (7)

Answer 5

• Markedly painful, immobile limb (Pseudoparesis)
• Acute febrile child
• Directly over infected site = swelling and exquisite tenderness – may be erythematous and warm
• Moving limb is severely painful
• May be a sterile effusion of an adjacent joint
• Presentation may be more insidious in infants, in whom swelling and decreased limb movement are initial signs
• Beyond infancy, may present with back pain in vertebral infection or limb/groin pain in infection of pelvis.