Early roentgen observations in acute osteomyelitis
01 Mar 1970-American Journal of Roentgenology (Am J Roentgenol Radium Ther Nucl Med)-Vol. 108, Iss: 3, pp 488-496
TL;DR: In order to appreciate the soft tissue changes that occur early in osteomyelitis it is most important that the normal as well as the abnormal side be examined roentgenographically.
Abstract: The roentgen examination can be very helpful in making the early diagnosis of osteomyelitis. Within the first 3 days after the onset of symptoms, soft tissue changes are visible roentgenographically. A local deep soft tissue swelling adjacent to the metaphysis of a growing bone without superficial edema should alert the radiologist to the possibility of osteomyelitis. The diagnosis is almost certain if there is also local tenderness clinically. Several days after the onset of symptoms, swelling of the deep muscles and obliteration of the lucent planes between the muscles are visible roentgenographically, even though the enlargement of the deep muscles may not be appreciated clinically. In order to appreciate the soft tissue changes that occur early in osteomyelitis it is most important that the normal as well as the abnormal side be examined roentgenographically.
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TL;DR: Of the patients with S aureus osteomyelitis, chronic disease occurred in 19% of those receiving parenterally administered antibiotics for three weeks or less, but in only one patient (2%) of those who received parenTERal antibiotics longer than three weeks.
Abstract: • One hundred sixty-three cases of osteomyelitis in infants and children were seen at our hospital during the past 15 years. There were twice as many boys as girls. Staphylococcus aureus was the major etiologic agent, being identified in 61% of the cases. Gram-negative bacteria were responsible for only 14 cases (9%). The femur, the tibia, or the humerus were affected in 103 of the 152 patients with single bone involvement. Osteomyelitis of more than one bone was seen in 11 cases (7%). Associated joint infection was confirmed in 29 patients. There were no deaths. Surgical drainage was carried out in 81 cases (50%). Ten patients had recurrent or persistent drainage and one developed a Brodie abscess. Of the patients with S aureus osteomyelitis, chronic disease occurred in 19% of those receiving parenterally administered antibiotics for three weeks or less, but in only one patient (2%) of those who received parenteral antibiotics longer than three weeks. ( Am J Dis Child 129:1273-1278, 1975)
281 citations
TL;DR: The annual incidence of osteomyelitis in Norway remains high and ESR values and MRI scan may help to identify osteomyeitis patients and differentiate acute and subacute osteomyeliitis.
Abstract: Osteomyelitis can be difficult to diagnose and there has previously not been a prospective approach to identify all children in a defined geographic area. The aim of this study was to assess the annual incidence of osteomyelitis in children, describe the patient and disease characteristics in those with acute (< 14 days disease duration) and subacute osteomyelitis (≥ 14 days disease duration), and differentiate osteomyelitis patients from those with other acute onset musculoskeletal features. In a population-based Norwegian study physicians were asked to refer all children with suspected osteomyelitis. Children with osteomyelitis received follow-up at six weeks, six months and thereafter as long as clinically needed. The total annual incidence rate of osteomyelitis was 13 per 100 000 (acute osteomyelitis 8 and subacute osteomyelitis 5 per 100 000). The incidence was higher in patients under the age of 3 than in older children (OR 2.9, 95%: CI 2.3–3.7). The incidence of non-vertebral osteomyelitis was higher than the incidence of vertebral osteomyelitis (10 vs. 3 per 100 000; p = .002). Vertebral osteomyelitis was more frequent in girls than in boys (OR 7.0, 95%: CI 3.3–14.7). ESR ≥ 40 mm/hr had the highest positive predictive laboratory value to identify osteomyelitis patients at 26% and MRI had a positive predictive value of 85%. Long-bone infection was found in 16 (43%) patients. ESR, CRP, white blood cell count, neutrophils and platelet count were higher for patients with acute osteomyelitis than for patients with subacute osteomyelitis. Subacute findings on MRI and doctor's delay were more common in subacute osteomyelitis than in acute osteomyelitis patients. Blood culture was positive in 26% of the acute osteomyelitis patients and was negative in all the subacute osteomyelitis patients. The annual incidence of osteomyelitis in Norway remains high. ESR values and MRI scan may help to identify osteomyelitis patients and differentiate acute and subacute osteomyelitis.
164 citations
Cites background from "Early roentgen observations in acut..."
...[7] Bone destruction is not apparent on plain radiographic films until 7 to 10 days after infection.[8] Bone scans are sensitive in the diagnosis of osteomyelitis (73% to 100%), [9-11] but the difficulty in separating bone-marrow processes from soft-tissue disease limits specificity and accuracy....
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TL;DR: Radiography, computed tomography, sonography, scintigraphy, and magnetic resonance imaging (MRI) all have roles and varying usefulness in the imaging evaluation of clinically suspected infection.
Abstract: Evaluation of clinically suspected infection is a common imaging task, in which many factors have to be taken into consideration, such as the pathogen (bacteria, mycobacteria, fungus, or virus), the location of the suspected infection (bone, soft tissue, joint, or disc space), the age of the patient (infant, child, adult), the time course of the infection (acute, subacute, chronic), and whether there are any underlying complicating factors (e.g., infarct or other bone disease, joint replacement in the area of clinical concern, or diabetic arthropathy). Radiography, computed tomography (CT), sonography, scintigraphy, and magnetic resonance imaging (MRI) all have roles and varying usefulness in the imaging evaluation.
142 citations
Cites background from "Early roentgen observations in acut..."
...The earliest radiographic changes are soft-tissue swelling and blurring of adjacent fat planes, which may take several days to become apparent after the onset of infection [2]....
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TL;DR: It seems improbable that an ideal model of osteomyelitis will be achieved in the near future, but further efforts to develop new experimental models and innovative research with present models are clearly needed.
Abstract: Because of the marked variability in presentation and management of osteomyelitis in patients, research with animal models that mimic the human disease offers a more controlled approach. Presently available animal models have been used to study pathogenesis, diagnosis, and treatment of osteomyelitis. Each model has advantages and disadvantages. Although it seems improbable that an ideal model of osteomyelitis will be achieved in the near future, further efforts to develop new experimental models and innovative research with present models are clearly needed.
140 citations
Cites background from "Early roentgen observations in acut..."
...In terms of diagnosis, we know that radiographic examination has relatively little value in acute osteomyelitis but serves as "the gold standard" for diagnosis of the chronic form [1, 2]....
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TL;DR: Clinical and radiological differences that in the past have led many authors to consider neonatal osteomyelitis a separate entity from osteomyeelitis in the older child are discussed.
139 citations
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