Osteomyelitis

Question 1

What is osteomyelitis?

Answer 1

An infection in the bone and bone marrow. Typically occurs in the metaphysis of the long bones.

Question 2

What is the most common bacterial cause of osteomyelitis?

Answer 2

Staphylococcus aureus.

Question 3

What is chronic osteomyelitis?

Answer 3

A deep seated, slow growing infection with slowly developing symptoms.

Question 4

What is acute osteomyelitis?

Answer 4

Presents more quickly with an acutely unwell child.

Question 5

How can the infection be introduced?

Answer 5

Directly into the bone (e.g., during an open fracture) or it can travel to the bone through the blood after entering the body through another route such as the skin or gums.

Question 6

Who is osteomyelitis common in?

Answer 6

Boys and children under 10 years.

Question 7

What are the risk factors of osteomyelitis?

Answer 7

Open bone fracture, orthopaedic surgery, immunocompromised status, sickle cell anaemia, HIV, tuberculosis.

Question 8

What is the presentation of osteomyelitis?

Answer 8

Can present acutely with an unwell child or more chronically with subtle features. Refusing to use the limb or weight bear, pain, swelling, tenderness. May be afebrile or may have a low grade fever. Children with acute osteomyelitis may have a high fever, particularly if it has spread to the joint causing septic arthritis.

Question 9

What investigations are used for osteomyelitis?

Answer 9

X-rays: often the initial investigation but can also be normal in osteomyelitis. MRI is the best for establishing diagnosis (bone scan is an alternative). Blood tests: will show raised inflammatory markers (CRP and ESR) and WBCs in response to the infection. Blood cultures: to establish causative organism. Bone marrow aspiration or bone biopsy with histology and culture may be necessary.

Question 10

What is the management of osteomyelitis?

Answer 10

Extensive and prolonged antibiotic therapy. May require surgery for drainage and debridement of the infected bone.