The accuracy of different imaging techniques in diagnosis of acute hematogenous osteomyelitis

Malcius, Dalius; Jonkus, Martynas; Kuprionis, Gintaras; Maleckas, Almantas; Monastyreckienė, Eglė; Uktveris, Rimantas; Rinkevičius, Sigitas; Barauskas, Vidmantas

doi:10.3390/medicina45080081

Cited by 60 publications

(55 citation statements)

References 38 publications

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“…In such an instance of extended diagnosis, which was carried out in two cases in the form of CT imaging, the exact bone structure can be assessed. With regard to the detection of osteitis, scintigraphy shows a high sensitivity but has unsatisfactory specificity [19]. Therefore, a negative scintigraphy probably excludes an infection.…”

Section: Discussionmentioning

confidence: 99%

Medium-term results after total clavicle resection in cases of osteitis: a consecutive case series of five patients

Oheim

Schulz

Schoop

et al. 2011

International Orthopaedics (SICOT)

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Purpose Claviculectomy is a rare and poorly described event in the surgical therapy of diseases of the clavicle. We present a case series and functional results of patients who underwent total claviculectomy. Methods From 1995 to 2006 a total of 26 patients diagnosed with osteitis of the clavicle underwent surgery in our unit. Of these, five patients (all female) needed a total resection of the clavicle in order to ensure permanent healing from infection. The data collection was prospective. The data gathered preoperatively and at follow-up included clinical examinations, laboratory findings, radiographs and the Constant shoulder scores. The mean follow-up period was 7.5 months. Results The surgical concept described was able to eliminate infection in all cases studied within an average hospital stay of 13.4 days (8-18 days). Only one patient showed complications; suffering from chronic pain syndrome requiring surgical revision. After total resection of the clavicle four of five patients showed very good functional results. The average Constant score showed a significant increase from 82 before surgery to 95 at follow-up. Conclusions The surgical technique described for total claviculectomy, along with the insertion of local antibiotic beads, was able to eliminate infection in every case. Good functional results and a low complication rates were observed. For good functional results and the permanent elimination of infection, adjacent joints have to be addressed, the periosteal tube should be preserved and early functional treatment is essential.

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Section: Discussionmentioning

confidence: 99%

Medium-term results after total clavicle resection in cases of osteitis: a consecutive case series of five patients

Oheim

Schulz

Schoop

et al. 2011

International Orthopaedics (SICOT)

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“…Blood cultures should be sent and bone biopsies may be taken if appropriate. Radiographs should be performed in all suspected cases but normally only show bony changes after 2 wk [17]. Ultrasound is another good modality to assess periosteal elevation, abscess formation, loculi and to assess the joint.…”

Section: Osteomyelitismentioning

confidence: 98%

The Limping Child — What a Pediatrician Should Know?

O’Dowd

Fernandes

2016

Indian J Pediatr

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Diagnosis of a limping child can be challenging for the clinician given the vast array of conditions that present in this manner. This review article discusses the history, examination and subsequent differential diagnoses that should be considered along with the most appropriate investigations for each diagnosis. The latest evidence regarding choice of investigation to make the clinician's task less onerous is also discussed.

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“…To the best of my knowledge, such a study has not been carried out, and in most comparisons either scintigraphy was done first [14] or MRI was used only in complicated cases [15]. Fig.…”

Section: Diagnostic Modalitiesmentioning

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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The accuracy of different imaging techniques in diagnosis of acute hematogenous osteomyelitis

Cited by 60 publications

References 38 publications

Medium-term results after total clavicle resection in cases of osteitis: a consecutive case series of five patients

Medium-term results after total clavicle resection in cases of osteitis: a consecutive case series of five patients

The Limping Child — What a Pediatrician Should Know?

Infection: musculoskeletal

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