1. Good MorningIt’s Friday!!! August 20, 2010

3. Osteomyelitis • 1% of pediatric admissions • Neonates* • Hematogenous spread* • Tibia or femur • 50% associated with septic joint* • GBS & E.Coli • Older children* • Staph aureus*, Group A Strep, HIB, Salmonella (SCD) • Rare joint involvement

4. Osteomyelitis • Direct invasion • Spread from focus • Trauma • Staph aureus • Puncture • Pseudomonas • Sole of sneaker • E. coli • Animal Bite • Anaerobes • Staph

5. Osteomyelitis • Hematogenous* • Acute pain and decreased movement* • Possible swelling or redness* • Systemic Symptoms • Fever • Malaise • Irritability

6. Osteomyelitis • Following trauma • Insidious, subacute onset • Localized pain, edema and redness • Absence of systemic symptoms • Chronic • Local findings may be absent or intermittent • Possible sinus tracts • Absence of systemic symptoms

7. Osteomyelitis • Lab findings • Elevated or normal leukocyte • ESR/CRP elevated • Positive blood culture • 50%

8. Osteomyelitis • Imaging • Plain films • 1-2 weeks* • Edema of surrounding tissues • Periosteal reaction • New bone formation • 2 weeks • Lytic lesions

9. Osteomyelitis • Imaging* • Bone Scan • 2-3 days • Unclear location • Nonspecific • MRI • Specific • Abscess

10. Pelvic Osteomyelitis* • Stats • Older children • Mean 8.1y • Boys > Girls • Ilium > ischium or pubis • Right > left • Increased risk for abscess formation • Late diagnosis • Staph aureus

11. Osteomyelitis • Treatment* • High dose • Bactericidal levels in bone • 4-6 weeks • Staph or Strep • Oxacillin or naficillin • 1st or 2nd generation cephalosporins • Clindamycin • HIB • 2nd or 3rd generation cephalosporin

12. Osteomyelitis • Treatment • Sickle Cell • 3rd generation cephalosporin • Other bugs to consider • Pseudomonas, anaerobes, GBS and E. coli

13. Osteomyelitis • Complications • Recurrence • 5-10% are chronic • Abscess