Radiologic Classification of Chronic Hematogenous Osteomyelitis in Children

Jones, Harold; Harrison, James W.; Bates, Jane; Evans, Gwyn A.; Lubega, Nicolas

doi:10.1097/bpo.0b013e3181b76933

Cited by 28 publications

(30 citation statements)

References 14 publications

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“…This classification system also allows description of physeal damage to long bones. It has been shown to have good inter-and intra-observer reliability, 19 and in practice the authors have found that it is useful in planning surgical management.…”

Section: Classificationmentioning

confidence: 99%

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Chronic haematogenous osteomyelitis in children

Jones

Beckles

Akinola

et al. 2011

The Journal of Bone and Joint Surgery. British volume

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From a global point of view, chronic haematogenous osteomyelitis in children remains a major cause of musculoskeletal morbidity. We have reviewed the literature with the aim of estimating the scale of the problem and summarising the existing research, including that from our institution. We have highlighted areas where well-conducted research might improve our understanding of this condition and its treatment.

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Section: Classificationmentioning

confidence: 99%

“…The Beit Cure classification system was developed specifically for chronic haematogenous osteomyelitis in children 19 ( Fig. 1).…”

Section: Classificationmentioning

confidence: 99%

Chronic haematogenous osteomyelitis in children

Jones

Beckles

Akinola

et al. 2011

The Journal of Bone and Joint Surgery. British volume

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“…In Gambia, for example, osteomyelitis accounted for 7.8% of paediatric surgical admissions and 15.4% of inpatient's days. [8] Due to the way of living, traditions and the social situation, osteomyelitis plays an important role in the developing countries. [8][9][10] In the industrialised countries, post-traumatic osteomyelitis plays only a minor role in children, in contrast to adults.…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment of chronic osteomyelitis in children admitted from developing countries

Wirbel¹,

Hermans²

2014

Afr J Paediatr Surg

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“…Chronic osteomyelitis may present with a relatively small focus of disease surrounded by a strong reaction of the host bone, which walls off the infection. This is termed a Brodie abscess, and is characterized by a necrotic center, a well-defined inner border, and a hazy, ill-defined and broader halo of infection [37]. A less well-contained focus of osteomyelitis can develop a necrotic center or sequestrum, surrounded by pus.…”

Section: Imaging Of Complicationsmentioning

confidence: 99%

Infection: musculoskeletal

Jaramillo

2011

Pediatr Radiol

102

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The imaging approach to osteomyelitis has evolved in the past two decades. Advances in MRI allow for whole body imaging, decreasing the need for scintigraphy when symptoms are not localized or the disease may be multifocal. There is an increasing clinical need for depiction of abscesses in the soft tissues and subperiosteal space, particularly because methicillin-resistant Staphylococcus aureus infections constitute more than one-third of all the infections. The increasing emphasis on radiation dose reduction has also led away from scintigraphy and computed tomography. MR imaging has become the advanced imaging modality of choice in osteomyelitis. There is an increasing understanding of the appropriate role for gadolinium enhancement, which is not indicated when the pre-gadolinium images are normal. Other related infections, including pyomyositis, are best imaged with MRI.Keywords Infection . Musculoskeletal . Children . MRI EpidemiologyAcute hematogenous osteomyelitis is the most common form of musculoskeletal infection [1]. Its incidence is difficult to determine, but it has been reported to be 1 per 5,000 [2]. There is conflicting data regarding the change of the disease over time. A study in 1998 found that the incidence in Norway ranged between 70 and 160 per million and that the incidence had remained stable between 1965 and 1994 [3]. An American study, however, found that in the last 20 years the incidence of osteomyelitis had increased 2.8-fold, whereas that of septic arthritis was stable. Methicillin-resistant Staphylococcus aureus (MRSA) was the causative organism in 30% of the children [4]. More than half of the cases occur before 5 years of age, and it appears to be more frequent in boys. Approximately 70% of infections involve the lower extremities and onethird affect the knee [2]. PathophysiologyHematogenous osteomyelitis results from the seeding of bacteria, usually Staphylococcus aureus (S. aureus) in the metaphysis of a long bone (Fig. 1) or in the metaphyseal equivalents of the axial skeleton (Fig. 2). S. aureus bacteria, which are present in the skin or mucosal membranes, enter the bloodstream and lodge in the bone, usually at sites where blood flow is abundant and slow. The metaphyses are richly vascularized and the valveless sinusoidal loops of the metaphyseal venules have sluggish flow and discontinuous endothelium which facilitates bacterial invasion. During childhood, the metaphyses that grow the fastest, such as those around the knee, are the most richly vascularized in order to produce new bone at a rapid rate. These rapidly growing metaphyses also tend to be affected more frequently by infection. S. aureus has the capacity to attach to the bony matrix and produce proteolytic enzymes that destroy the surrounding tissues, allowing the spread of the infection. From the bone, the infection extends through the porous metaphyseal cortex into the subperiosteal space. The periosteum in children is loosely attached to the bone and separates easily from it, creating a space that allows ...

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Radiologic Classification of Chronic Hematogenous Osteomyelitis in Children

Abstract: The results suggest that our classification system for chronic hematogenous osteomyelitis in children is reliable.

Cited by 28 publications

References 14 publications

Chronic haematogenous osteomyelitis in children

Chronic haematogenous osteomyelitis in children

Surgical treatment of chronic osteomyelitis in children admitted from developing countries

Infection: musculoskeletal

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