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Pediatric Osteomyelitis M86.8X9 730.2

 

synonyms:

Pediatric Osteomyelitis ICD-10

Pediatric Osteomyelitis ICD-9

  • 730.2 Unspecified Osteomyelitis

Pediatric Osteomyelitis Etiology / Epidemiology / Natural History

  • 1/5,000 children
  • Generally in children younger than 5 y/o.
  • M:F = 2:1
  • Most common organsism = S aureus. Others: group A beta-hemolytic streptococcus, Haemophilus influenzea, Kingella kingae( after URI), salmonella(sickle cell patients), bartonella henselae (cat-scratch disease), Pseudomonas aeruginosa (puncture wounds in feet).

Pediatric Osteomyelitis Anatomy

  • Generally occurs at metaphyseal-epiphyseal junction of long bones (femur, tibia, humerus).

Pediatric Osteomyelitis Clinical Evaluation

  • Fever and limb pain, limp
  • Neonates: pseudoparalysis, pain with palpation, local swelling, decreased appetite, inconsolable crying.
  • Infants/toddlers: fever, irritability, limp, inability to bear weight, swelling, warmth, erythema,
  • Older children/adolescents: pain, fever

Pediatric Osteomyelitis Xray / Diagnositc Tests

  • CBC with differential, ESR (rises within 2 days, continues to rise for 3-5 days even with treatment), CRP (rises witin 6 hours, peaks at 48 hrs, normal witin 1 week), blood cultures, gram stain, CXR. Consider Acid-fast staining, fungal cultures, prolonged incubation times (especially for infections after arthroscopic surgery).
  • Xray: demonstrate soft-tissue swelling / loss of tissue planes early. Bone abnormalities require 30-40% bone losss.
  • MRI: highest sensitivity and specificity for infection / osteomyelitis. low signal intensity in bone marrow on T1 images may indicated osteomyelits (bone marrow normally has high-signal intensity on T1 images).
  • Bone scan: technetium 99m; gallium citrate Ga 67; indium-111 leukocyte-labeled etc.
  • Fine needle aspiration.

Pediatric Osteomyelitis Classification / Treatment

  • Acute: IV antibiotics for 4/6 weeks determined by culture and senstivities. Result of antibiotic treatment is best monitored with serial CRP levels. CRP should decline within 72hrs with appropriate treatment (Unkila-Kallio L, Pediatrics 1994;93:59).
  • Chronic (any patient with subperiosteal abcess, soft-tissue abcess, sequestra, intrameduallar purulence): Operative debridement and IV antibiotics for 4/6 weeks determined by culture and senstivities.

Pediatric Osteomyelitis Associated Injuries / Differential Diagnosis

Pediatric Osteomyelitis Complications

Pediatric Osteomyelitis Follow-up Care

  • Follow responce to treatment with serial ESR and CRP. CRP returns to normal in 1 week, ESR in 3 weeks with adequate treatment.

Pediatric Osteomyelitis Review References