Acute hematogenous osteomyelitis in children. Osteomyelitis in a child: causes, symptoms, treatment Osteomyelitis in a child signs

Any inflammatory and purulent process in a child’s body is always very difficult. Osteomyelitis in children is a very serious and serious disease that can occur at almost any age. This pathology is characterized by purulent-necrotic damage to the bone marrow, bone tissue itself and periosteum with the involvement of surrounding soft tissues in the process. This disease is difficult to diagnose in the early stages of development, which often does not allow doctors to start etiotropic therapy in time, i.e. aimed at eliminating the causal agent.

Epiphyseal osteomyelitis that occurs in a child is highly likely to lead to changes in the structure and shape of the bone. And subsequently this predisposes to problems requiring orthopedic treatment and correction.

The tubular bones of a child, which are most often susceptible to osteomyelitis, consist of 3 sections:

1. Epiphyseal parts. These are the ends of bones that have anatomical structures to connect to other bones, form joints, and attach ligaments and muscles.
2. Diaphyseal part. This is the middle part of the bone that contains the channel for the bone marrow.
3. Metaepiphyseal parts. They contain growth plates that allow the baby's bones to grow in length.

The bone is also covered with periosteum, which provides its nutrition and growth in thickness. Due to the vessels that pass directly into the bone marrow canal, the so-called endosseous blood supply (intraosseous) occurs.

It is precisely this feature of the trophism of tubular bones in the human body that becomes a prerequisite for the occurrence of an isolated focus of purulent-necrotic inflammation in the bone marrow, which is limited by the bone from the surrounding soft tissues.

Based on the ways the infection enters the bone, the following types of disease are distinguished:

• Hematogenous osteomyelitis. The pathogen enters the child’s bone marrow through the bloodstream, most often from another source of the infectious process in the child’s body. This type of disease occurs most often in children.
• Post-traumatic osteomyelitis. It develops as a result of trauma (hematoma, bone fracture, disruption of the integrity of soft tissues) followed by purulent inflammation. The pathological process can spread, including to the bone tissue and the brain contained there.
• Iatrogenic osteomyelitis. A purulent-necrotic process in the bone occurs as a consequence of medical interventions (surgeries on bone tissue, intraosseous injections, etc.).
• Other types of disease, associated mainly with contact migration of infection into the bone from nearby areas of affected soft tissue.

There is a fairly wide range of reasons that can provoke osteomyelitis in a child. They are mainly associated with the presence of another chronic focus of inflammation, the pathogen from which migrates in the body with the bloodstream.

Reasons for the development of osteomyelitis in children

The main cause of the disease is the entry of infectious agents (bacteria or viruses) into the cavity of the bone marrow canal.

According to the results of various studies, Staphylococcus aureus was detected in children in the vast majority of cases of hematogenous osteomyelitis. For disseminated forms of the disease (when multiple foci of purulent inflammation are observed in the bones), anaerobic infections are more typical pathogens.

As a rule, the reasons for the development of osteomyelitis in a child are:

1. Presence of a focus of infectious process, which becomes the source of migration of disease pathogens into bone tissue. Such a primary focus is not always easily identified by a doctor during examination. Dental caries, chronic tonsillitis, otitis, sinusitis, enterocolitis and other diseases can serve as a source of bacteria that, migrating with the bloodstream, affect the bone marrow.
2. Congenital infection in a child. In some cases, the occurrence of osteomyelitis in newborns is associated precisely with intrauterine infection or the entry of an infectious agent into the child’s body during childbirth.
3. A general decrease in the activity of the immune system. This condition can be caused by both congenital and acquired immunodeficiency syndromes in a child. Especially often, a decrease in immunity is observed during viral diseases or certain bacterial infections (tuberculosis, brucellosis, etc.), as well as during oncological processes.
4. Local decrease in blood flow to the bone and a decrease in local immune defense activity. Such conditions are provoked mainly by hypothermia, inflammation of soft tissues in the bone area, etc.
5. Traumatic effects on bone and soft tissue. This process not only causes the development of an inflammatory reaction, the formation of hematoma and edema, accompanied by impaired bone blood flow. It also provokes the development of an infectious process.

Thus, the development of osteomyelitis in a child is associated with the presence in the body of a potential causative agent of purulent-necrotic inflammation (most often in the form of an already existing focus of inflammation in the body), as well as general and local disorders of the vascular and immune systems.

The structural features of the vessels that feed the bone in the epiphysis zone (they end blindly, without connecting with other vessels) determine the occurrence of epiphyseal osteomyelitis.

Symptoms of the disease

The disease usually begins and progresses acutely. Less commonly, osteomyelitis can be chronic with periodic episodes of exacerbation of symptoms. Hematogenous osteomyelitis in children occurs with the following clinical picture:

1. A sharp increase in body temperature (up to 40-41 degrees), fever.
2. Severe weakness and intoxication caused by a high concentration of bacterial or viral toxins in the blood.
3. Increasing, severe pain in the bone, which intensifies with palpation, axial load, walking, etc.
4. Local skin changes (redness, swelling, etc.) are not always characteristic of the first day of the disease.
5. In parallel, inflammatory phenomena can be observed in the primary infectious focus (tonsils, maxillary sinuses, caries teeth, etc.).
6. If the infectious focus is located in the epiphysis of the bone, arthritis, an inflammatory process in the joint, may occur.

How is the disease diagnosed?

Diagnosis of a disease such as acute hematogenous osteomyelitis in children on the first day is the key to a speedy recovery. The earlier the pathology is identified, the faster comprehensive measures will be taken for local sanitation of the purulent focus and systemic therapy with antibacterial drugs. Therefore, after assessing the child’s symptoms, the doctor urgently prescribes the following tests to confirm the diagnosis:

• X-ray of the area of ​​bone in which osteomyelitis is suspected to develop. Unfortunately, at the beginning of the disease, which is caused by direct infection in the bone marrow canal, such a study is not very informative. However, in the future, with the progression of osteomyelitis, X-ray changes in the bone leave no doubt about this diagnosis in the child.
• Evaluation of clinical blood test. Osteomyelitis is characterized by a significant increase in the level of leukocytes and pronounced changes in the leukocyte formula. These signs indicate the presence of an inflammatory process of an infectious nature in the body.
• Blood culture determination is a procedure for culturing blood to assess the presence of bacteria in it, as well as subsequently determining their sensitivity to antimicrobial drugs.
• Ultrasound of bones and soft tissues in the suspected zone of disease development. It allows early detection of indirect signs of osteomyelitis.

Some forms of the disease, for example acute odontogenic osteomyelitis, are distinguished by the fact that they begin and proceed as normal inflammation of the tissues around the diseased tooth, and then suddenly become complicated by the transition of the process to the bone marrow. Most often, according to this scenario, events develop in the lower jaw.

Chronic osteomyelitis in children occurs with episodes of minor exacerbation of the process, but with pronounced phenomena of destruction of bone tissue and the frequent formation of purulent fistulas (pus can come out onto the skin) and bone sequesters (areas of bone that have separated from the main mass). Often this form of the disease is causally related to purulent processes in the teeth and their buds. This leads to the development of a disease such as chronic osteomyelitis of the jaw bones.

Diagnosis and treatment of osteomyelitis of any form in children is carried out only in a surgical department under the constant supervision of doctors.

Treatment of osteomyelitis in children

Therapy for this disease should begin as early as possible. It is this feature of the treatment of osteomyelitis that allows one to avoid bone destructive changes, as well as the development of sepsis and shock conditions (septic shock). Treatment of osteomyelitis is based on three main principles:

1. Sanitation and provision of access to all foci of purulent inflammation in the bone through surgery. To do this, osteoperforation is performed - special punctures are made and holes and channels are formed to the pathological focus. This allows you to introduce antibiotics and antiseptics there, as well as reduce intraosseous pressure, which causes severe pain. Osteomyelitis of the jaw also requires sanitation of the oral cavity and removal of problematic teeth, which serve as the primary source of inflammation and infection.
2. Intravenous administration of antibacterial drugs taking into account the sensitivity of microflora to them. Unfortunately, the exact spectrum of osteomyelitis pathogens, as well as their response to various antimicrobial agents, can only be determined by studying a blood culture or culture of pus from the site of infection. But the result will be obtained only after 5-7 days. Therefore, treatment of the disease begins with several strong broad-spectrum antibiotics in order to inactivate a very large list of potential pathogens of the infectious process.
3. Maintaining homeostasis and providing symptomatic therapy. To do this, infusion of various intravenous solutions is used, the task of which is to correct the child’s water and electrolyte balance, equalize the pH of the blood, and also remove toxins that accumulate in the blood from the body. To relieve (eliminate) fever, as well as pain, non-steroidal anti-inflammatory drugs with pronounced antipyretic and analgesic properties are used. To improve local blood microcirculation in the bones, vascular drugs are prescribed.
4. Limb immobilization, in which osteomyelitis occurred. This measure is especially important for young children, since functional rest of the bone reduces the severity of pain and reduces inflammatory swelling. However, immobilization should not exceed an average of 4 weeks to prevent local disturbances of tissue trophism and the occurrence of muscle atrophy.

Only an integrated approach to the treatment of osteomyelitis in children of any age, which includes all of the above measures, can prevent the development of severe complications of this disease. Timely detection of osteomyelitis in children of any age is the key to stopping the disease at a stage when destructive changes in the bone have not developed, which may affect the function and appearance of the limb in the future.

What is osteomyelitis?

Osteomyelitis in newborns is a purulent inflammation of the bone, characterized by necrotic processes that affect not only the bone marrow, but also soft tissue.

The infectious process, reaching a chronic form, can lead to irreversible deformations of the children's skeleton. The disease is considered quite dangerous, since an abscess that develops in the bone tends to spread, affecting soft tissue.

In especially advanced cases, necrosis begins.

Pathogenesis (disease development)

The sedimentation of bacteria from the blood at the ends of long bones is due to the peculiarities of the structure and blood supply of the latter. The arteries break up under the growth plates into non-anastomosing capillaries, which form short loops before entering the venous sinuses (draining into the bone marrow).

Blood flow in these areas is slow, creating an ideal environment for bacteria to colonize.

In older children, the periosteum adheres more closely to the bone, and pus seeps through it. In late adolescence (after the closure of growth plates), the process often begins in the diaphysis and can spread throughout the intramedullary canal.

Causes

class=»fa»>The main carriers of the disease through the blood are staphylococci and streptococci.

The infection can begin when blood carries bacteria into the bone tissue. Also, the impetus for pyogenic processes can be an infection that has entered the body through the wound surface, or an infection that has passed from inflamed soft tissue to the bone.

In case of injury accompanied by a wound, the causative agents are several different microorganisms, one of which may be the dangerous Pseudomonas aeruginosa.

Hematogenous (spread through the bloodstream) osteomyelitis arises after an infectious disease:

• purulent sore throat;
• otitis;
• suppuration in diseased teeth;
• panaritium;
• furunculosis;
• inflammation of the umbilical ring in infants;
• pneumonia, etc.

Osteomyelitis in newborns can develop due to weak body resistance before the age of one year.

Since children are restless, the greatest risk group is injuries and purulent infections. At the same time, boys get sick more often than girls, as they often get injured during games.

In case of infection, the cause may be boils, impetigo, otitis media, pyelonephritis. The causative agent of the inflammatory process is Staphylococcus aureus.

If we are talking about a newborn, the disease manifests itself in the first two weeks. Its cause is insufficient care, maternal mastitis or microtraumas that open the door to infection.

​Pathomorphology of acute hematogenous osteomyelitis​​If parents miss time, the disease will develop into​

​For patients with sickle cell anemia: Ciprofloxacin or third generation cephalosporins (Ceftriaxone, Cefotaxime, Cefoperazone).​

Osteomyelitis causes

According to the course, odontogenic osteomyelitis can be acute and chronic. According to prevalence, they are distinguished: limited, focal and diffuse.​

​Treatment of hematogenous acute osteomyelitis consists of prescribing: antibiotic therapy, detoxification therapy, immunocorrection, antioxidant therapy, desensitization, limb immobilization, metabolic correction, biostimulation, vitamin therapy, and the use of laser blood irradiation.​

​Also, the formation of subperiosteal abscesses, adenophlegmons and peri-maxillary phlegmons occurs. Osteomyelitis of the upper jaw with a diffuse course is complicated by phlegmon of the orbit, thrombophlebitis of the facial veins, and sinusitis.​

Depending on the cause that led to osteomyelitis, the disease is classified as follows:

1. the nonspecific form is caused by pus-forming harmful microbes;
2. specific osteomyelitis becomes a secondary disease after tuberculosis, syphilis, and brucellosis.

Osteomyelitis is an inflammatory process of a purulent-necrotic nature that affects the bone tissue surrounding the periosteum and bone marrow. The causative agents of osteomyelitis, in the vast majority of cases, are staphylococci and streptococci.

The “entry gate” of infection can be purulent skin lesions, omphalitis, catheterization of the umbilical vein, and frequent blood sampling from the heel. Such processes are caused by a nonspecific form of the disease, that is, bacteria enter the body hematogenously (through the bloodstream).

Simply put, the infection can be acquired in utero, or in the maternity hospital (see article Staphylococcus in newborns). Intrauterine infection can be diagnosed in cases where sepsis is detected in a newborn immediately after birth.

staphylococcus, mainly aureus;

group B, E, coli streptococci;

coli;

salmonella;

Pfeiffer wand;

gram-negative enterobacteria.

Lesions of osteomyelitis

Osteomyelitis primarily affects long bones, but can affect the bones of the skull, face, ribs, sternum, small bones of the arms and legs, and the proximal segments of the humerus and tibia. Most often, the lesion occurs on the femur and upper jaw.

Clinical picture

Manifested by general and local symptoms.

There are 2 forms of the disease: toxic-septic and septicopyemic.

The toxic-septic form is characterized by acute and severe symptoms of intoxication. It usually occurs against the background of sepsis.

The septicopyemic form manifests itself mainly with local symptoms. The general condition of the newborn suffers little. Clinical symptoms are absent or subtle. During diagnosis, intermediate forms of other purulent-inflammatory processes are often identified. The distribution of osteomyelitis foci can be chaotic or form a certain sequence.

Types of osteomyelitis in children

Osteomyelitis was assigned a code according to ICD 10 in children - M86. If there is a need to identify an infectious agent, then additional coding B95-B98 is used. When the pathology is caused by salmonella, it is assigned the code A01-A02.

According to etiology there are:

• Nonspecific osteomyelitis, which is caused by microbes that form pus;
• Specific, which is a consequence of tuberculosis, brucellosis, syphilis. The most severe form is recurrent multifocal osteomyelitis, leading to damage to long bones. Often in such a situation the foot and hip joint suffer.

Symptoms

Symptoms of osteomyelitis in children are directly related to the age of the child, the stage of the pathology, and the cause that caused it.

Acute form

Acute osteomyelitis in children is characterized by rapid development and is presented in several forms. Local, in which the inflammatory process affects soft tissues and bones. Usually the child’s general condition does not suffer. The septic-pyemic form is accompanied by:

• Increased body temperature;
• Chills;
• Migraine;
• Nausea;
• Vomiting;
• Fainting;
• Impaired coordination;
• Blood clotting disorders;
• Swelling;
• Hormonal imbalance;
• Deterioration in the functioning of the liver and kidneys.

The toxic form is characterized by blood poisoning, which causes the following symptoms:

• Vomiting;
• Increased body temperature;
• Convulsions;
• Decreased blood pressure;
• Heart failure.

Interesting! Osteomyelitis in newborns gives more vivid symptoms than in older children, who often experience only a slight deterioration in general health.

Chronic form

If the disease is not diagnosed and treated in a timely manner, chronic osteomyelitis appears in children. During this period, the sign of poisoning subsides, but the general well-being of young patients deteriorates sharply.

In the affected area, fistulas with accumulated pus appear. The chronic stage of the disease is characterized by subsidence of symptoms and relapses. Remission can sometimes last for years.

Symptoms of osteomyelitis in children are pronounced, but vary depending on the source of inflammation. Subsequent treatment depends on this.

Diagnosing the disease in infants is often complicated by the fact that the symptoms are too similar to the manifestations of other disorders. The main symptoms are:

• diarrhea;
• vomit;
• lethargy and weakness;
• severe anxiety;
• decreased appetite.

Examination shows redness of the skin at the site of inflammation. The child spares the limb, trying not to move it or touch it.

The older child will complain of ever-increasing pain, which may subside after the abscess ruptures. With palpation and movement, the pain intensifies.

The chronic form is a consequence of improper or insufficient treatment of an acute disease. The course of the disease is characterized by variable periods of exacerbation and remission.

Odontogenic osteomyelitis in children exhibits other symptoms:

• chills and fever;
• malaise and weakness;
• severe inflammation of the causative tooth and its elevation above the dentition;
• severe swelling;
• inflammation of the lymph nodes;
• painful jaw closure.

Osteomyelitis of the jaw in children is diagnosed quite easily, since all the signs are pronounced.

Signs and symptoms of a bone infection vary by age. The earliest clinical manifestations often do not attract attention.

Newborns may experience pseudoparalysis or pain when moving the affected limb. In 50% of cases there is no fever, the child looks completely healthy.

In later life, fever and pain are more common; Local signs also appear: swelling, redness and local temperature increase. Approximately 50% of children with lower limb impairment begin to limp or refuse to walk.

Acute osteomyelitis gives the following symptoms:

• fever, chills and sweating;
• headache;
• general weakness;
• vomit;
• pain, swelling, redness of the tissue located directly above the inflammation in the bone;
• enlarged lymph nodes;
• painful symptoms worsen when chewing and talking (especially if it is osteomyelitis of the lower jaw);
• if treatment is not carried out, the pus will try to come out, and a fistula may form in the affected area.

​Infection of bones from neighboring tissues in which purulent processes occur.​

Next, the inflammatory process breaks out, forming multiple channels communicating with each other and fistula tracts. With good immunity and adequate antimicrobial therapy, the infection dies. Otherwise, the process takes a long time. Sometimes it becomes chronic.​

Sequence grass – 1 teaspoon;

It is known that acute odontogenic osteomyelitis develops as a result of caries and other dental diseases. In this case, in order to relieve symptoms and speed up recovery, you need to frequently rinse your mouth with a solution of sea salt.

This drug is a natural antiseptic. Dissolve a teaspoon of salt in a glass of warm water, take the liquid into your mouth and hold for at least 30 seconds, then spit the liquid into the sink.

Repeat the procedure 5-7 times a day (necessarily after meals). Remember that odontogenic osteomyelitis requires urgent treatment of carious teeth.

​X-rays show areas of osteoporosis and severe osteosclerosis, a sequestral capsule, and a sequestral cavity in which the sequestra are located.​

​Pathomorphology of acute hematogenous osteomyelitis​

Pour dried buds or flowers of purple lilac into a liter jar to the top and fill with vodka. The composition must infuse for ten days. The strained tincture can be used in compresses on the affected limb, and you can also give two drops orally to the child every day until recovery.

​Symptoms of osteomyelitis in children​

​Mix a chopped large onion with grated laundry soap. Place this mixture on a cloth and apply to the sore spot, secure on top with a bandage. Such compresses can be done at night every day until the symptoms of the disease completely disappear.

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Brief description of the disease

​Manifestations of osteomyelitis largely depend on the age of the child, his immunity and the affected area of ​​the bone.​

​In order to say even the shortest and simplest words, we use 72 muscles.​

Acute osteomyelitis - symptoms and clinical picture

​Found an error in the text? Select it and press Ctrl Enter.​

Treatment methods with folk remedies

Osteomyelitis is characterized by an inflammatory disease of the bones, as well as the bone marrow (Greek osteo - bone, myel - brain, the ending “itis” means inflammation).

If you go to the surgical department of a children's hospital, you can see many children who are there after surgery, the cause of which was osteomyelitis. This disease is most common in infants and small children; the cause of osteomyelitis is injury and infection.

There are many times more boys among the sick than girls, all this can be explained by the fact that the cause is injuries. Boys run, fall, and hit themselves much more often, which is why they suffer.

The second cause of osteomyelitis is purulent infections; they can develop due to furunculosis, otitis, burns, weeping wounds that become infected. The causative agents of osteomyelitis are mainly staphylococci, streptococci, E. coli, and salmonella.

Such a disease as osteomyelitis has been known to mankind for more than 3000 years. It was known to Hippocrates, who was the first to give a detailed description of the disease and advice on its treatment.

Nowadays, osteomyelitis is much less common, which is associated with the widespread use of antibiotics, but hundreds of research laboratories are still struggling to find an effective drug against this pathology.

This attention of specialists is due to the fact that osteomyelitis in children and adults directly affects bone tissue and bone marrow, which is very, very dangerous, especially at an early age.

Chronic osteomyelitis produces less noticeable symptoms. In newborns, the disease is even more difficult to diagnose. The baby may refuse to feed, be nervous and whiny.

Treatment

For acute forms:

• a sharp rise in temperature;
• swelling;
• vomit;
• diarrhea;
• convulsions;
• irritability and restlessness of the child as a manifestation of a pain reaction;
• increased content of leukocytes and ESR in the blood test.

Visual signs:

• change in the appearance of the joint;
• signs of soft tissue inflammation;
• unusual position of the affected limb;
• avoidance of movements;
• restriction of active movements of the limb;
• deformation of the adjacent joint;
• large anatomical and radiological changes in bones;
• swelling over the lesion;
• development of phlegmon.

Diagnosis of osteomyelitis

Early diagnosis of osteomyelitis is the key to a complete recovery. After assessing the symptoms, the doctor prescribes studies to confirm or refute the diagnosis:

• X-ray of bone. This type of diagnosis is not informative at the very beginning of the development of pathology. Subsequently, as the disease progresses, the X-ray image shows the presence of a pathological compaction, the absence of boundaries in the soft tissues;
• CBC (General blood test). The presence of osteomyelitis is indicated by an increased level of leukocytes. A markedly altered leukocyte count shows inflammation;
• Culture, which allows to identify the causative agent of the disease and determine the antibiotic that is sensitive to it;
• Ultrasound allows early detection of swelling and muscle changes;
• MRI accurately diagnoses the chronic form of the disease;
• CT visualizes the acute form more clearly.

In children, the development of osteomyelitis most often begins with damage to the bone marrow, after which the infection spreads to the periosteum and the bone itself. In the hematogenous form, diagnosing this disease is very difficult. For children under one year old, almost the only symptoms are increased restlessness and immobility of the affected limb.

It is very difficult to diagnose osteomyelitis in a young child, since there are no “adult” symptoms in children under one year of age. Osteomyelitis can be suspected if the child becomes very restless, and at the same time does not move an arm or leg (as if sparing it).

Laboratory tests1. A complete blood count indicates bacterial inflammation.

2. Biochemical blood tests also reveal the inflammatory process and diagnose renal and liver failure in the toxic form.

1. The most common method for diagnosing osteomyelitis is radiography.

Characteristic changes can be seen on x-rays only on days 8-10 (bone loss, periosteal reaction). 2

Ultrasound is used to determine muscle damage. 3

Infrared scanning – identifies areas with elevated temperature, thereby identifying hidden foci of osteomyelitis. 4

Computed tomography has the greatest diagnostic value, which visualizes the affected area layer by layer, which allows you to see the degree of soft tissue damage (hidden lesions, the presence of fistulas), the presence of sequesters.

When the history and examination data suggest osteomyelitis in children, it is necessary to puncture the affected area, followed by Gram staining of the punctate and culture, which allows confirming the diagnosis.

The contents of the joint or pus from the bone are the best material for sowing. If gonococcal infection is suspected, bacterial cultures should also be obtained from the cervix, anus, and pharynx.

Any suspicion of osteomyelitis or suppurative arthritis requires a blood culture.

There are no specific laboratory indicators of osteomyelitis in children. Indicators such as the total number of leukocytes and leukocyte formula, ESR and C-reactive protein are very sensitive, but nonspecific and do not distinguish infectious bone lesions from other inflammatory processes.

In the first few days of the disease, the white blood cell count and ESR may remain normal, but on this basis the diagnosis of a bone or joint infection cannot be excluded.

At the same time, dynamic determination of ESR and C-reactive protein makes it possible to evaluate the effectiveness of therapy and helps to identify complications.

Radiation research methods play a vital role in the diagnosis of osteomyelitis in children. For diagnostic purposes, conventional radiography, ultrasound, CT, MRI and radionuclide studies are used.

Initially, a plain X-ray is usually performed to rule out trauma and the presence of foreign bodies. MRI is widely used as a very sensitive and specific diagnostic method.

In the absence of an acute form, the picture of the disease may be erased, and the clinical signs may be atypical. According to statistics, this picture is observed in 22% of newborns with primary signs of osteomyelitis. This makes it difficult to diagnose the disease in the early stages.

1. Radiography. An informative, but rather outdated diagnostic method. The fact is that the first radiological changes in osteomyelitis appear no earlier than 7–12 days from the onset of clinical symptoms of the disease. In some cases this period is extended.

• identifying complications of osteomyelitis, if any.

1. CT scan. This method consists of layer-by-layer examination of the body using x-rays. Radiation exposure is present, but its negative impact is minimal.

• high information content;
• painlessness.

1. Diagnostic bone puncture followed by bacterioscopic examination. Allows you to determine the condition of the bone marrow and identify the nature of the lesion.
2. Rheoplethysmography. A bloodless method for studying blood supply due to the electrical resistance of tissues when current passes through them.

Plus - painlessness.

Disadvantage: the method is not widely used.

1. Ultrasound. The method guarantees high diagnostic accuracy – up to 89%.

• painlessness;
• allows you to identify signs of the disease, starting from the second day of a child’s life.

Treatment

Treatment of osteomyelitis in a child should begin as early as possible. In this case, the development of sepsis and bone changes can be avoided. Therapy of the disease is based on the following principles:

• Pediatric surgeons perform osteoperforation, in which antiseptics and antibiotics are injected through the formed holes into the inflammatory focus. The surgery relieves the pressure inside the bone that causes pain;
• Intravenous administration of antibiotics for 5-7 days;
• Conducting symptomatic treatment to eliminate fever, relieve pain, and remove toxins from the circulatory system. For this purpose, nonsteroids, analgesics, and vascular agents that improve blood microcirculation are prescribed;
• The application of splints to ensure rest in the affected limb is a feature of the treatment of children. This measure allows you to reduce swelling and relieve pain. Immobilization should not be carried out for more than a month. Otherwise, muscle atrophy may develop.

Important! Children suffering from osteomyelitis are subject to mandatory hospitalization in a hospital.

Antibiotics for osteomyelitis are prescribed for a long time, the course of treatment is 3 months. An important condition for recovery is taking multivitamins and immunoglobulins.

After acute symptoms are relieved, children need rehabilitation, which lasts for six months. Children are prescribed vitamins, therapeutic massage, and gymnastics. The exercise is prescribed individually, based on the condition of the little patient. Further, to exclude relapses, it is necessary to undergo a comprehensive examination every six months.

Even at the end of the 19th century, surgeons had to resort to amputation of the affected limb or radical trepanation, when the bone canal was opened with a chisel to the bone marrow and manually cleared of purulent-necrotic contents.

Now treatment of osteomyelitis in children is carried out using various radical methods:

1. The body must get rid of the infection that causes the disease. In the fight against osteomyelitis, antibiotics are used, for example, gentamicin or fusidine. Simpler antibiotics, such as penicillin, cannot cope with such a powerful infection.
2. At the same time, the body is cleansed of intoxication - plasma is transfused or the blood is purified by hemosorption, passing through a column with activated carbon or other sorbent.
3. Local treatment of the diseased area of ​​the limb is carried out using physiotherapy and fixation with a plaster splint.
4. The patient’s immunity is increased by various methods, with the help of vitamins and immune stimulants.
5. In some cases, surgical intervention occurs - the bone is trephinated, cleansed of purulent-necrotic secretions, fistulas are removed, and drainage is installed. In severe advanced cases, the area of ​​bone that has become the source of the disease is removed.

Treatment of bone infection requires the collaboration of pediatricians, orthopedic surgeons, radiologists and exercise specialists.

Antibiotics. When prescribing antibiotics for osteomyelitis in children, they are based on ideas about the most common bacterial infections at a given age, data from Gram staining of punctures, and a number of additional factors.

In newborns, antistaphylococcal penicillins (nafcillin or oxacillin IV 150-200 mg/kg per day every 6 hours) and broad-spectrum cephalosporins are used.

In children under 5 years of age, the main causative agents of osteomyelitis are S. Aureus and streptococcus, and in vaccinated children - N.

influenzae. Cefuroxime acts on these bacteria.

In children over 5 years of age, almost all cases of osteomyelitis are caused by gram-positive cocci. Antistaphylococcal antibiotics, for example nafcillin, cefazolin, can be administered.

If your child has osteomyelitis of the jaw, it will be possible to put him back on his feet only after long-term treatment and rehabilitation. In severe cases, bone replacement surgery is prescribed. To make the healing process more effective and quick, you can use folk remedies.

Modern therapy for childhood osteomyelitis is based on two main principles - the effect on micro- and macroorganisms and directly on the focus of the disease (that is, the affected area of ​​the bone). All treatment methods are carried out in a hospital setting:

• immunotherapy;
• desensitizing therapy - subcutaneous administration of staphylococcal antiphagin, staphylococcal toxoid, filtrate, staphylococcal, streptococcal vaccine, bacteriophage to lose the body's hypersensitivity to the allergen;
• vitamin therapy;
• antibiotics;
• local decompression - elimination of compression of the bone marrow, its vessels and roots, removal of pathological formations that compress vascular and nervous structures, often combined with stabilization;
• fixation of the affected area;
• periostotomy is a surgical operation in which the periosteum (periosteum) is dissected with (partial) detachment from the bone;
• drainage (outflow, pumping out purulent contents) of phlegmon (focus of inflammation) of soft tissues.

After discharge from the hospital, outpatient massage, physical therapy, sanitation of affected areas, and balneotherapy (exposure to mineral waters) are performed. Inpatient treatment continues to be carried out twice a year (usually in autumn and spring), including immunomodulators, desensitizing, magnetic, laser and vitamin therapy, electrophoresis with antibiotics.

A control X-ray examination is carried out regularly: six months after discharge, and then once a year for three years. Sanatorium-resort treatment plays an important role in the rehabilitation of children.

If you ignore the basic methods of therapy, the consequences of this disease can be very disastrous.

It is carried out only in a hospital setting.

The course of the disease depends on the number and type of pathogens, as well as their virulence (pathogenicity).

Low-level laser therapy. The essence of the method is the effect of low-intensity light on the affected areas of the body. The laser does not cause tissue heating. Being gentle and painless, this method has many advantages.

• cell metabolism is activated;
• microcirculation of blood flow increases;
• pain syndrome is relieved;
• provides an immunostimulating effect;
• swelling is relieved;
• the range of movements increases.

Today, the use of laser is one of the most effective treatment methods. The treatment has been proven to be highly effective compared to other methods.

For the treatment of newborns, suprafocal continuous exposure to a laser with a wavelength of 0.63 mW is used. Clinical recovery occurs faster, bone destruction (destruction) progresses less.

Antibacterial therapy. A loading dose of broad-spectrum drugs is prescribed. As a rule, penicillins or cephalosporins are prescribed. The duration of the course is at least 3-4 weeks. The drugs are administered intra-articularly or intravenously.

Symptomatic treatment. Is auxiliary to antibacterial therapy. Consists of prescribing medications to relieve and relieve pain and inflammatory symptoms.

Surgical intervention. Under local anesthesia, the affected area is opened and the pus is subsequently removed. Next, the bone canal is washed with special solutions.

It is possible to install drainage of the affected bone by suctioning out the pus. The affected limb is kept immobilized until the inflammatory process is stopped and normal bone structure is ensured.

Immunotherapy, vitamin therapy. It is possible to administer immunoglobulins and gamma globulins.

Help from traditional medicine

Walnut tincture. It is infused for two weeks and is recommended for oral administration until the pain syndrome is completely relieved.

Compresses made from green nuts infused with alcohol. This infusion is also prepared for two weeks, but is used in the form of compresses applied to the site of inflammation. Treatment is carried out within a month.

Lilac tincture. Lilac is infused in alcohol for ten days, after which it is used in the form of compresses.

Still, traditional medicine does not cope well with all diseases, so one should not underestimate possible complications and do not neglect modern medicine.

To avoid osteomyelitis in children, it is necessary to carry out preventive measures. These include more than just immediately treating an open wound sustained during play or a fall with disinfectants.

It is necessary to regularly conduct a medical examination and consult with your doctor regarding strengthening the immune system.

If you suspect an infectious disease, you should immediately seek medical help. Other inflammations cause a weakening of the immune system and make infection easier. All diseases must be cured.

Incorrect or insufficient treatment can cause the disease to become chronic, which does not bring anything good. It is necessary to carefully monitor the child’s condition and contact experienced specialists, whether it is maxillary or epiphyseal osteomyelitis.

And we can also add that with timely and correct diagnosis of the disease, the result of subsequent treatment, the severity of the consequences and the complexity of treatment depend.

Possible complications

If the disease is not detected in a timely manner and its prompt treatment is not started, complications may develop:

• Bone defects;
• Child growth disorder;
• Frequent leg injuries;
• Arthritis.

Osteomyelitis of the jaw (odontogenic osteomyelitis) can be complicated by life-threatening meningitis; - a complication such as sepsis is very life-threatening.

With this complication, the bacterial infection enters the bloodstream and spreads throughout the body, causing more and more purulent foci.

The main complications of osteomyelitis include disability as a result of bone destruction and deformation. In addition, the presence of a constant purulent process leads to depletion of the immune system, degeneration of organs and tissues, and impaired physical and mental development.

After osteomyelitis, children may develop various types of complications:

• various bone defects;
• joint instability;
• destructive (tissue destroying) dislocation;
• bone growth disorders;
• in children, one of the most common consequences is arthritis of the extremities;
• the chronic stage of the disease develops - secondary chronic osteomyelitis, which in the future will lead children to problems with posture;
• when the spinal cord is pinched, the entire musculoskeletal system is injured;
• Osteomyelitis of the upper jaw, often diagnosed in boys, can provoke meningitis, which will lead to changes throughout the body;
• if the disease affects children's legs or hip joint, in advanced forms complete immobilization may occur.

Despite the often diagnosed osteomyelitis in children and such serious consequences after it, modern medicine successfully carries out therapy and gives the most favorable prognosis. Fatalities are recorded less and less frequently by statistics.

Parents need to know that preventing the disease is very simple. They are only required to be more attentive to the health of their children, ensure that any of their wounds and injuries are not infected (to do this, it is enough to treat them with alcohol), and seek medical help in a timely manner.

Prevention of pathology

To prevent infection, you should follow simple rules:

1. All wounds, cuts, and open fractures must be treated with alcohol or another antiseptic.
2. Do not touch open wound surfaces with dirty hands.
3. For any injuries that involve an open wound, consult a doctor.
4. All foci of chronic infection must undergo regular thorough sanitation.
5. You should treat your health with care and follow the rules of basic safety and personal hygiene.

Prevention of osteomyelitis in newborns helps to avoid serious consequences - it is not without reason that such strict hygiene rules have been established for little people. The simplest inflammation of the umbilical ring in a baby, which is not treated in time by a careless mother, can lead to tragedy.

Untreated, combed wounds after a mosquito bite, which a child touches with dirty hands, open the gates to terrible microorganisms. A seemingly simple abscess in a child’s sore tooth, which the parents did not pay attention to, can ruin his entire life.

Osteomyelitis does not tolerate being taken lightly; it lurks where you don’t expect it. Do not neglect the simplest safety measures - consult a doctor in time for a quick diagnosis of the disease, so that later you do not have to resort to severe surgery.

Of course, in the modern world, osteomyelitis rarely causes death, but it is worth remembering the threat of becoming disabled.

Preventive measures consist of simple actions. It is important to prevent injury and monitor what the child does during the day. If there are open wounds, burns or other damage to skin tissue, they should be immediately treated with disinfectants.

Chronic infections undermine the immune system, making it easier for bacteria to enter the body. Therefore, it is recommended not to let the disease progress and to conduct a timely medical examination if you suspect various types of infectious diseases.

Prevention methods are identical to those for any type of osteomyelitis - this is protecting the child from injuries and wounds, carrying out complete sanitation of all foci of chronic infection.

It is important to actively strengthen the immune system and reduce the allergenicity of the body, maintain a physical regime, without overloading the skeleton.

In children, non-hematogenous forms of osteomyelitis are extremely rare; most often, the infection penetrates into the affected area through the bloodstream from foci of purulent infection in the body. Osteomyelitis in children (hematogenous) is a common acute disease, the formation of a purulent-necrotic zone of destruction of bone marrow, bone and periosteum in an organism that is highly allergic or has a pronounced decrease in immunity. It is more often registered among boys; children of any age are affected, but preschoolers are most predisposed.

Most often, purulent skin infections lead to osteomyelitis - boils or impetigo, skin burns, otitis media, wounds, pyelonephritis. The main microbe will be staphylococcus, it is detected in 80% of children, less often it is salmonella, E. coli, streptococci and others. Infection is facilitated by a decrease in immune defense and increased infection. In addition, the process of spreading infection in the bone area is facilitated by their structure and blood supply. Arteries are densely intertwined with tissue and bone marrow and have many loops where blood circulation is slow and where microbes can become active.

The bones of children have a special structure; they contain a lot of bone marrow; the periosteum is closely adjacent to the bone, which allows pus to seep through it into the tissue. Most often the vertebrae, humerus and femur, forearm, pelvis, and lower jaw are affected.

In acute osteomyelitis, active proliferation of microbes occurs in the area of ​​the bone marrow and bone, which leads to the formation of an abscess, melting of the tissue around it and the creation of tissue damage for the release (breakthrough) of pus to the outside.

Symptoms

Acute osteomyelitis occurs differently depending on the form of infection. When toxic, it develops with lightning speed, and general manifestations predominate, including sepsis. There is a sharp rise in temperature to 40 degrees and above, with the development of loss of consciousness, delirium and convulsions, the formation of a state of shock, damage to the lungs and kidneys. In this condition, the site of osteomyelitis is difficult to detect; usually this form is lethal within 2-3 days.

In the severe form with septicopyemia, severe chills occur with a fever of 39 degrees or higher, severe symptoms of intoxication, and acute pain in the affected bone. Over the course of two days, local changes occur with the progression of pain and the development of phlegmon - purulent destruction of bone and tissue. In its place there is sharp pain and redness, the skin temperature is elevated, and there is swelling. A fistulous tract with outflow of pus or melting of muscle tissue may be detected.

In the local form, the general phenomena are generally not very pronounced, mainly only the affected bone suffers.

General symptoms of an acute hematogenous process are paralysis of a limb or pain with the slightest movement, slight fever, gradually increasing symptoms of swelling, redness and increased temperature at the site of abscess formation. Children limit the functions of the affected limb or area, refuse to walk, and lie down. The lesion is usually on one bone, in rare cases there are two or more foci of osteomyelitis.

Diagnosis of acute osteomyelitis in a child

The basis of diagnosis is clinical data, as well as puncture of the affected area to obtain pus, culture it and identify pathogens. It is sown on nutrient media to determine sensitivity to antibiotics. In parallel with this, blood culture, general analysis and biochemistry are performed.

There are no specific changes in the analyzes - they indicate the presence of an acute purulent process, without an exact indication of its nature and location. The ESR, the level of special C-reactive protein, and leukocytosis are sharply increased.

The most important diagnostic method is digital x-ray; the images show areas of bone destruction. Tomography or MRI, as well as ultrasound of joints and tissues, are also indicated; if necessary, isotope scanning of bones is performed.

Bone puncture with intraosseous temperature measurement and tonometry are indicated. They reveal an increase in temperature and pressure in the affected area. Showing bone marrow sampling with its cytological examination, skin thermometry and thermal imaging.

Complications

The main complications of the acute process are the formation of false joints, pathological fractures, bone defects, shortening of the limbs, dislocations and instability of the joints, and impaired skeletal growth.

The transition to chronic forms, bone destruction and spread of infection throughout the body with the formation of sepsis and death is dangerous.

Treatment

What can you do

There are no home treatment methods; osteomyelitis is dangerous and can only be treated in a hospital under the supervision of a doctor.

What does a doctor do

The basis of treatment is the simultaneous influence on the microbe and suppression of the purulent process with stimulation of the resistance of the body itself. First of all, an active course of antibiotics is indicated, taking into account the sensitivity of the pathogen to them; they are administered intravenously. The same applies to the focus of inflammation with adequate decompression and unloading of the bone, the use of antibiotics locally in the focus, fixation of the affected bone, and surgical treatment of osteomyelitis lesions with excision of the affected tissue and removal of pus with drainage.

In parallel with this, the body is detoxified with the introduction of special solutions into a vein, immunotherapy, vitamins and drugs against inflammation and allergies are used.

An important point will be the further rehabilitation of the child and his active monitoring. Physical therapy and massages, treatment of foci of infection and sanatorium rehabilitation are indicated. Courses of preventive treatment are continued for another three years with control X-rays.

Prevention

The basis of prevention is the timely treatment of foci of chronic infections in the oral cavity and pharynx, treatment of colds, strengthening the immune system, and preventing injury to the skeleton.

Hello, dear parents. Today we will talk about what osteomyelitis is in children. You will become aware of the main signs of the disease. Find out the reasons for the development of this condition. Familiarize yourself with diagnostic methods and treatment methods. Let's talk about precautions.

Classification

Osteomyelitis is a disease in which the bone marrow is damaged, accompanied by the accumulation of pus, which was caused by infection. If the necessary treatment is not given, necrosis may form.

Damage can be observed:

• in the thigh bones;
• in the legs;
• in the vertebrae;
• in the humerus;
• in the jaw.

The causative agents of this disease are:

• pneumococci;
• streptococci;
• Staphylococcus aureus.

The disease can also develop after injury. If the disease is not stopped in time, it will develop into a chronic condition, purulent areas will begin to grow, and this will cause underdevelopment of the skeleton and its deformation.

Based on etiology, two types of osteomyelitis are distinguished:

• specific - the result of a serious infectious disease;
• nonspecific - the disease is provoked by microorganisms that form pus.

Based on how the pathogens entered the body, consider:

• hematogenous osteomyelitis in children, which is primary - the lesion occurs due to the penetration of pathogens into the circulatory system;
• non-hematogenous - occurring after injury when adjacent tissue is damaged.

Based on the nature of the disease, consider:

• acute form;
• chronic.

Based on the symptoms of the disease, there are three types of acute forms of the disease.

1. Local. Characteristic:

• temperature rise to 38 degrees;
• changes are observed on the skin;
• the condition is accompanied by severe pain;
• local tissue swelling;
• the skin is hot on palpation;
• hyperemia, as well as fluctuation, develop quite quickly.

1. Toxic. Intoxication of the body occurs due to the presence of purulent foci. Characteristic:

• a sharp increase in temperature, up to forty-one degrees;
• the occurrence of hallucinations, possible clouding of consciousness;
• the pulse becomes difficult to discern;
• at the initial stage - no change in skin color is observed.

1. Septic-pyemic:

• the child feels very weak;
• the temperature rises to thirty-nine degrees, relapsing fever is possible;
• after a couple of hours, severe pain occurs, which will be diffuse;
• symptoms such as toxicosis, weakened heart sounds, tachycardia are also present;
• from the third day, the affected area may begin to swell, severe hyperemia will occur, and the pain will become localized;
• If the child is not treated, the pus will spread to other bones, as well as parenchymal internal organs, resulting in the formation of pyaemic foci.

Causes

The disease develops due to the penetration of pathogenic microorganisms into the bloodstream, damage to the bone marrow

In most cases, osteomyelitis is caused by infection of the bone marrow canal. If we consider metaepiphyseal osteomyelitis, then this disease occurs due to infection with Staphylococcus aureus. If the disease is accompanied by a large number of purulent foci, then the causative agent will be anaerobic bacteria.

Let's look at what causes of osteomyelitis are most common in children.

• a congenital infection caused by intrauterine infection or possible infection during the passage of a child through the birth canal;
• consequences of slowing blood flow due to inflammation of soft tissues or hypothermia;
• the presence of a chronic infectious process in the body (for example, enterocolitis);
• reduced immunity of congenital or acquired nature;
• inflicted trauma - in this case, post-traumatic osteomyelitis develops against the background of formed hematomas, impaired bone blood flow, and an emerging infectious process;
• Epiphyseal osteomyelitis can occur due to the anatomical features of the vessels that feed the bone.

Characteristic symptoms

The child experiences pain in the affected areas of the bones

How the disease will manifest directly depends on the age of the baby, the causes of the pathology, and the stage of the disease.

The acute form of osteomyelitis in infants can be mistaken for other pathologies. Since the main manifestations of this condition are:

• general weakness;
• diarrhea;
• lethargy, severe anxiety;
• vomiting is possible;
• attacks of fever;
• lack of appetite;
• in the affected area you may notice redness of the skin;
• the baby will practically not move the affected limb.

Acute osteomyelitis in children may be accompanied by the presence of special symptoms. They will differ depending on the form that is present.

The septic-pyemic form has the following manifestations:

• chills;
• lack of coordination;
• faintness and;
• nausea, possible;
• migraine;
• swelling;
• changes in hormonal levels;
• blood clotting is impaired;
• problems with the functioning of parenchymal organs.

The presence of a toxic form may be indicated by the following manifestations:

• vomit;
• temperature rise;
• convulsions;
• heart failure.

With the local form of acute osteomyelitis, the baby’s condition may not suffer much, except for manifestations on the skin.

The chronic form is characterized by:

• the appearance of fistulas in the affected area, pus accumulates in them;
• the development of relapses that resemble the acute form of the disease, but the manifestations are less pronounced - an exacerbation may be a consequence of the presence of a closed fistula in which a purulent process will occur.

Symptoms of traumatic and hematogenous chronic osteomyelitis:

• pain in the affected area;
• pus begins to ooze if there is an open wound;
• the appearance of gray plaque at the site of inflammation;
• destruction of bone tissue is observed, joint deformation occurs;
• muscle atrophy may occur;
• in the presence of a long-term chronic process, shortening of the affected limb occurs;
• Metabolic processes in the body deteriorate, as a result of which failure of internal organs develops.

Diagnostics

Timely diagnosis allows you to start treatment on time, prevent degeneration into a chronic form, and get rid of undesirable consequences.

After the doctor examines the little patient, collects all the complaints, prescribes an examination that will help refute or confirm the alleged diagnosis.

1. General blood analysis. Based on the results, it is possible to identify the presence of an inflammatory process in the body.
2. Ultrasonography. Makes it possible to detect muscle changes and swelling at an early stage.
3. Sowing. Allows you to determine the type of pathogen, as well as its sensitivity to certain groups of antibiotics.
4. . This diagnostic method will not be appropriate if the disease is at an early stage, but as the disease progresses, pathological compactions can be seen in the image.
5. . Allows you to determine chronic osteomyelitis.
6. CT. Suitable for acute forms.

Possible complications

Arthritis may develop due to untreated osteomyelitis

If proper treatment is not provided and in a situation where the child’s condition was not diagnosed in time, the baby does not receive the necessary therapy, serious consequences may develop:

• deterioration of posture;
• underdevelopment and defectiveness of the bones that were affected;
• deviations in the functioning of joints (becomes noticeable when walking);
• if the leg bones were affected - inability to move independently;
• if there has been recurrent osteomyelitis of the jaw, it can develop;
• dysfunction of the joints, arthritis of the lower extremities;
• purulent foci may form in the internal organs.

Treatment

Therapy will be prescribed depending on what stage the disease is at and what type of course it is; the age of the child will also be taken into account.

1. Symptomatic therapy aimed at:

• removal of inflammatory processes;
• decrease in temperature;
• pain relief;
• decreased sensitivity to possible allergens;
• restoration of homeostasis processes.

1. Immunotherapy. Its goal is to increase immunity. The child will be given calcium supplements, vitamin injections, glucose drips, and immunoglobulins will also be used. If osteomyelitis is diagnosed in newborns, then it is extremely important to maintain breastfeeding.
2. Immobilization of bones that are affected. They can be fixed for up to four weeks.
3. Antibiotic therapy. The child is prescribed broad-spectrum antibiotics, followed by specific ones. In the situation with newborn children, cephalosparins and antistaphylococcal penicillin are prescribed, for children from one to five years old - Cefuroxime, for children over five years old - Cefazolin and Nafcillin. A course of antibiotics can last up to three months.
4. In the presence of intraosseous pressure, suppuration in the bones, and the development of necrotic areas, surgical treatment methods will be used.

You cannot do without a course of restorative therapy, which may include:

• massage;
• physical therapy;
• electrophoresis;
• laser therapy;
• vitamin therapy;
• magnetic therapy;
• spa treatment.

Precautionary measures

It is necessary to monitor the general well-being of the child and pay great attention to personal oral hygiene

Parents can follow certain rules that will allow them to reduce the risk of osteomyelitis in their child. To do this you need:

• create a daily routine and strictly follow it;
• take the baby for necessary medical examinations;
• timely treatment of infectious diseases;
• make sure there are no injuries;
• if there are wounds or bruises that are accompanied by damage to the skin, promptly treat and disinfect them;
• Maintaining oral hygiene for the baby is of great importance.

Now you know what osteomyelitis of bones in children is. Remember that it is necessary to diagnose this disease in time to prevent the development of complications. Do not forget about the need to regularly visit the pediatrician and treat chronic processes, as well as infections in the child’s body.

The content of the article

Classification of osteomyelitis

Acute hematogenous osteomyelitis

Etiology of acute hematogenous osteomyelitis

Clinic of acute hematogenous osteomyelitis

Diagnosis of acute hematogenous osteomyelitis

Complications of acute osteomyelitis

Treatment of acute osteomyelitis

Rehabilitation of acute osteomyelitis