|
Year |
2002 |
|---|---|
|
Question Number |
214 |
|
Category |
Pediatric Orthopaedics |
Question
An 8-year-old girl has had left arm pain for the past 6 weeks. A plain radiograph, axial T1- and T2-weighted MRI scans, and a biopsy specimen are shown in Figures 61a through 61d. Based on these findings, the next most appropriate step in management should consist of
1- observation with serial radiographs.
2- IV antibiotics.
3- curettage and bone grafting.
4- wide excision only.
5- wide excision with chemotherapy.
Figures
Answer (click for answer)
Answer: 2
The answer is IV antibiotics. This child likely has hematagenous osteomyelitis. Hematagenous osteomyelitis has distinctive clinical features. In the usual presentation, a child younger than 15 years presents with fever, pain, and loss of function around a joint. Severe local bone tenderness is a cardinal sign of osteomyelitis. The plain radiographs show a lytic area in the bone with a periosteal reaction forming on the adjacent cortex. T1- and T2- weighted MRI scans show a subperiosteal abscess. The gram stain shows non-specific inflammatory cells. At the very least, this child would require IV abx. In acute osteomyelitis in the adolescent, IV antibiotics is usually sufficient for treatment. With chronic osteomyelitis, IV antibiotics with surgical debridement is more likely warranted. Staph Aureus is the most common organism encountered.
Reference: McCarthy EF, Frassica FJ: Infections of bone and joints, in McCarthy EF, Frassica FJ (eds): Pathology of Bone and Joint Disorders with Clinical and Radiographic Correlation. Philadelphia, PA, WB Saunders, 1998, pp153-164.