Osteomyelitis in older children, pediatric surgery. Acute hematogenous osteomyelitis in children

The disease is caused by bacteria that produce pus, which enters the blood (and then bone tissue) through the skin, mucous membranes, and umbilical cord. The most susceptible to damage are: lower leg, thigh, humerus, vertebra, upper jaw and mandibular joints. However, as a consequence of injury, the process can develop in any bone. Multiple bone lesions with osteomyelitis are also possible. Boys are more susceptible to the disease due to the fact that they are more mobile and, therefore, more often receive all kinds of injuries.

Classification and etiology of osteomyelitis, possible complications

Depending on the course of the disease, there are:

Acute - most often develops in children.
Chronic - occurs when, when bone tissue is damaged, leukocytes accumulate in them, destroying the bone, and gradually its dead areas are separated from healthy ones, creating conditions for the appearance of a chronic infection.

Depending on the etiology there are:

Specific - caused by any diseases (Staphylococcus aureus, streptococcus, E. coli, salmonella, tuberculosis, syphilis, leprosy, brucellosis), that is, it is secondary.
Nonspecific - occurs as an independent disease caused by pus-forming harmful microbes (foci of purulent infection - impetigo, boils, otitis, burns, pyelonephritis, wounds).

There are several ways that infection can enter a child’s body. The most common route is through the blood. This type of osteomyelitis is called “hematogenous”. In the case of such an infection in newborns, it may enter the bloodstream through a damaged umbilical cord. There is also a non-hematogenous route - in this case, the infection can spread from the affected tissues surrounding the bone. Often this type develops as a result of various injuries.

Types of injuries that can trigger the development of such an inflammatory process: gunshot wounds, postoperative complications (endoprosthetics, dental fillings, treatment of fractures), jaw injuries (as a result of which odontogenic osteomyelitis of the jaw bones develops), open fractures.

Factors that increase the risk of developing the disease:

presence of internal infection;
inflamed tooth;
lack of vitamins due to poor nutrition;
presence of open fractures;
impaired renal and liver function;
splenectomy.

This disease, in the absence of timely and adequate treatment, can cause such serious consequences as arthritis (often observed in infants), formation of a false joint, bone sclerosis, ankylosis, fractures, bone deformations, impaired growth, and possible pleurisy (inflammation of the rib bones). ), meningitis (with damage to the skull bones), sepsis, damage to internal organs.

Clinical manifestations of acute and chronic osteomyelitis

Symptoms of bone inflammation depend on the stage of development of the disease, the cause that caused it, the baby’s health condition and his age. In general, acute hematogenous osteomyelitis is characterized by rapid development (over several days) and has 3 forms of manifestation:

Local. In this form, the inflammatory process is limited to the area of bones and soft tissues, and the patient’s condition may be satisfactory.
Septic-pyemic. This form is manifested by the following symptoms: high body temperature (), delirium, chills; headache; vomit; loss of consciousness; severe localized pain; if inflammation has developed in the bones of the limbs, then they lose mobility, stop bending and unbending (development of contracture); there is swelling and redness of the soft tissues, a local increase in temperature, expansion of the subcutaneous venous network; blood clotting disorder; disturbances in the functioning of the immune, hormonal system, liver and kidneys (subsequently the skin becomes yellow).
Toxic (adynamic). It is characterized by the occurrence of acute sepsis (blood poisoning), develops very quickly, and is manifested by symptoms such as: increased body temperature, nausea and vomiting, loss of consciousness, convulsions, a sharp decrease in blood pressure, acute cardiovascular failure.

Osteomyelitis in newborns occurs with less pronounced manifestations of local symptoms than in older children (pain in the affected areas, etc.): mainly there is a deterioration in the general condition. The chronic form of osteomyelitis develops in the absence of acute treatment or as a result of injury. If acute inflammation becomes chronic, the patient’s condition improves, and signs of intoxication (poisoning of the body) fade away.

In the zone of infectious lesion (focus), fistulas are formed (one, several, sometimes a complex network) - channels lined with epithelial or granulation tissue that connect areas of inflammation with the external environment, that is, they open to the surface of the skin and through them there is an outflow of purulent contents from the foci. . Chronic osteomyelitis is characterized by alternating stages of remission and relapse.

Remission can last for several weeks or years. During this period, the symptoms subside, discharge from the fistulas is small, or they close. The stage of relapse is similar to the course of acute osteomyelitis, but the clinical manifestations are less pronounced. Among the reasons that provoke a relapse is the closure of the fistula, which leads to the accumulation of pus.

Treatment methods and diagnosis

To make an accurate diagnosis, you need to contact a qualified rheumatologist who will prescribe your child the necessary tests and hardware studies.

In some cases, a consultation with a surgeon may be necessary.

Examination and history taking.
General blood and urine tests.
Biopsy of bone and bone marrow and subsequent bacteriological examination of the material.
Radiography.
Tomography.
Fistulography (necessary in the presence of fistulas).
Radioisotope research.

A child with osteomyelitis must be hospitalized without fail and receive treatment under the strict supervision of the attending physician, which depends on the nature and severity of the disease. This may include:

Both local and systemic drug therapy (antibacterial, immunoglobulins, vitamins, anti-inflammatory drugs, traditional medicine).
Normalization of nutrition: it is necessary to consume large amounts of vitamins and minerals
Physiotherapeutic procedures and therapeutic massage.
From the first days of the disease, transfusion of plasma and detoxifying blood substitutes;
Hemosorption is the removal of toxic products from the blood outside the body using special substances (sorbents).
Hyperbaric oxygenation (HBO) is a treatment method using oxygen under high pressure, carried out in pressure chambers.
Surgical treatment (in the initial stages - flow-through drainage of the bone through trephination (hole), in advanced cases it is necessary to open the abscess, open washing, and then remove the lesion and fistulas, if necessary, remove the damaged part of the bone.

The main condition for a successful outcome in the treatment of osteomyelitis is a timely visit to a doctor when symptoms are detected and strict adherence to recommendations, as well as the exclusion of attempts to independently treat the disease.

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Why is bone osteomyelitis dangerous?

Bone osteomyelitis is a very common infectious disease of bone elements, which affects the bone marrow, leading to its destruction and necrosis. The disease was described in detail by Hippocrates, who spoke in detail about its symptoms and gave examples of how to treat this disease.

Osteomyelitis is an infectious bone disease

Nowadays, complicated forms of the pathological process are extremely rare.

Mostly the disease is diagnosed in the early stages and is easily cured with modern antibiotics. Increased attention to osteomyelitis on the part of doctors is explained by numerous complications of the pathological process, which lead to serious consequences, especially in pediatric patients.

Etiology of the disease

Osteomyelitis of bone tissue belongs to the group of infectious diseases, the main etiological factor in the development of which are the following pathogenic microorganisms:

Staphylococcus aureus;
coli;
rickettsia;
fungal infections;
Pseudomonas aeruginosa;
streptococci.

Doctors know exactly the causes of osteomyelitis, which cause the development of a pathological process in the osseous brain.

Often the main etiological factor in the occurrence of the disease is hidden bacterial and viral infections, autoimmune reactions, bone injuries and stressful situations.

Osteomyelitis often develops against the background of chronic diseases of the nasopharynx and oral cavity, diabetes mellitus, open fractures, ulcers, burns, cancer, and blood disorders.

You will learn all the details about osteomyelitis from the video:

Modern classification

According to the degree of prevalence, it is customary to distinguish localized (local) and generalized osteomyelitis. Depending on the type and duration of the disease, the osteomyelitis process can be acute or chronic.

According to the modern classification of osteomyelitis, the following types of bone infection are distinguished:

hematogenous (through blood);
by direct infection through a wound surface formed when the integrity of the skin is broken, burns, etc.;
spread of infection from chronic foci, for example, with diseases of the oral cavity, caries, tonsillitis and much more.

Depending on how the infection entered the body, osteomyelitis is divided into:

Localized osteomyelitis can be caused by various reasons

Variants of the course of the disease

Symptoms of osteomyelitis directly depend on the course of the disease.

Based on the nature of the development of signs of osteomyelitis and the duration of the disease, the following are distinguished:

acute hematogenous osteomyelitis;
chronic hematogenous osteomyelitis;
acute odontogenic osteomyelitis;
chronic odontogenic osteomyelitis;
post-traumatic osteomyelitis.

Acute osteomyelitis

Acute osteomyelitis, which occurs as a result of hematogenous infection of bone tissue, develops mainly in childhood. The favorite localization of this variant of the disease is the long tubular bones of the lower extremities.

Thus, acute osteomyelitis of the femur occurs in 50% of the total number of diagnosed cases of pathology, while a similar osteomyelitis of the calcaneus occurs in only 0.8% of patients.

Acute hematogenous osteomyelitis in children is much more complicated than in adult patients. Against the background of elevated body temperature, babies experience intense pain in the affected bones, redness of the skin over them and swelling in the area of infected tissue.

Symptoms of acute hematogenous osteomyelitis in children

Despite this, acute forms of osteomyelitis, even without therapeutic treatment, quickly regress, transforming into chronic osteomyelitis within 2-3 weeks after the onset of the disease. Symptoms of osteomyelitis in children in some cases are combined with osteoporosis of bone tissue, which is explained by its poor blood supply.

Acute odontogenic osteomyelitis

Acute odontogenic osteomyelitis is manifested by symptoms that are not much different from the signs of a pathological condition with hematogenous spread. As a rule, this type of disease occurs against the background of reduced immunity and occurs with the formation of foci of necrotic tissue deprived of blood supply.

It is impossible to completely restore the bone marrow after such disorders, which is especially dangerous in the case of spinal osteomyelitis with the spread of purulent inflammation to the spinal cord.

The consequences of this scenario can often be paresis and paralysis of the limbs, loss of sensitivity over large areas of the body and the appearance of parasthesia.

Chronic osteomyelitis

Chronic osteomyelitis can occur primarily or be the result of advanced acute inflammation. Primary chronic osteomyelitis is characterized by a rather sluggish course, sometimes by the absence of symptoms and characteristic changes in the blood. This variant of the disease leads to the formation of abscesses, areas of sclerotic tissue or areas with characteristic bone marrow calcification.

Chronic osteomyelitis leads to the formation of abscesses

The secondary chronic process occurs against the background of low-grade fever and is manifested by slight soreness of the bones, impaired function and general malaise.

Patients sleep poorly and constantly complain of loss of strength and loss of performance.

Over time, fistulas appear at the site of the lesion, from which pus with an unpleasant odor begins to be released. Chronic purulent osteomyelitis can last for several years and, without treatment, have serious consequences, including patient disability and death.

Diagnostics

Diagnosis of osteomyelitis makes it possible to identify this pathological process even at the initial stages of its formation. Doctors can determine the disease through clinical blood tests, as well as instrumental bone examinations.

Thanks to the X-ray signs of osteomyelitis, an experienced doctor is able not only to suspect the development of alarming symptoms, but also to accurately determine the form of the disease, suggest a variant of its development and establish the extent of the pathological process.

X-ray allows for an accurate diagnosis

To confirm the main diagnosis, modern clinics use computed tomography, bone ultrasound, and contrast radiography.

Possible consequences

Currently, osteomyelitis is successfully cured when it comes to non-advanced variants of the disease. Unfortunately, there are cases when patients ignore the initial symptoms of the disease and turn to specialists with advanced forms or complications of osteomyelitis, including pathological fractures, generalization of the purulent process, bone necrosis and much more.

Sometimes the consequence of osteomyelitis can be a septic condition, when the infection generalizes and spreads to all internal organs.

As a rule, the consequences of the disease depend on the location of the inflammatory process. Osteomyelitis of the leg is dangerous due to loss of limb function with the development of gangrene, and osteomyelitis of the sternum is dangerous due to pathological fractures of the bone, in which its fragments can disrupt the integrity of the walls of the heart or rupture the pleural membrane covering the lungs.

Treatment: modern approaches to therapy

Treatment of osteomyelitis can be conservative and surgical.

Drug therapy

Drug therapy for the disease is indicated for patients with localized primary forms of inflammation that occur without complications. In such cases, the doctor prescribes a course of antibiotics to the patient, taking into account the sensitivity of the pathogenic microorganisms to them that caused the development of the purulent process.

Antibiotics suppress the purulent process

It is advisable to combine antibiotics for osteomyelitis with immunomodulators, which help improve the body’s supporting functions and speed up recovery.

Surgery

Surgical treatment of osteomyelitis is the main option for eliminating purulent inflammation of the bone marrow and its complications. In some cases, patients are recommended osteosynthesis, removal of damaged areas of bone or osteoperforation with the introduction of special solutions into the bone canal that kill pathogenic microorganisms.

The results of treatment depend on several factors: timely diagnosis of the disease, the patient’s support reactions and his desire to recover faster.

Only a competent approach to therapy and full interaction between the patient and the attending physician will allow a person to achieve positive effects from treatment and forever forget about such a terrible disease as bone osteomyelitis.

Causes and treatment of osteomyelitis in children

Osteomyelitis is diagnosed in children more often than in adult patients, due to the characteristics of the immune system. The disease is not contagious and is a purulent process that is localized in the bones and bone marrow. The chronic stage of the disease can cause serious bone deformities. Mostly the disease is diagnosed in the femur, lower leg, and spine.

Reasons for the development of the disease

Osteomyelitis in a child appears due to infection in the bloodstream or in an open wound. The main cause of the disease is Staphylococcus aureus, which is diagnosed in half of the cases. Pathogenic bacteria enter the body through the mucous membranes, due to injury to the skin. In children under one year of age, microorganisms can penetrate the umbilical wound.

The focus of purulent and inflammatory processes in this pathology is not always in the bone. Infection also occurs from nearby organs and tissues. For example, acute odontogenic osteomyelitis in children provokes oral caries. In addition, bone marrow damage is sometimes observed, after which the surrounding tissues are affected. As for open injuries, infection most often occurs due to open fractures. In addition, purulent tonsillitis, the presence of boils and inflammation of the tonsils can also cause the appearance of osteomyelitis in young patients.

Classification of the disease

Children's osteomyelitis is divided into 2 types depending on the routes of infection into the body:

Bacteria can enter the bone canal through the blood.

Hematogenous. Damage to the bones of the legs and other areas occurs due to the entry of bacteria through the blood.
Non-hematogenous. Infection is observed due to open wounds and inflammatory processes in the soft tissues adjacent to the bones. This type of osteomyelitis is also called secondary.

Classification of the disease involves its division based on the reasons that provoke the occurrence of infection:

Specific form. The disease develops due to the penetration of pathogenic bacteria into the body.
Non-specific. Osteomyelitis appears due to previously diagnosed tuberculosis and syphilis.

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What symptoms does the pathology have?

Acute stage of osteomyelitis in children

The classification of the clinical picture is related to the stage of the disease, causes and age of the child. The acute degree of the disease develops quickly and has 3 forms:

In newborn children, the symptoms are less pronounced than in older young patients. Mostly parents only note a deterioration in their general health.

Chronic degree

If we talk about the chronic stage of the described disease, then it appears when timely treatment of acute osteomyelitis is not carried out or after injuries to the skin. When the disease becomes chronic, the symptoms of poisoning of the body subside, but the general health of the little patient deteriorates greatly.

In the area of the source of infection, fistulas appear, inside of which pus accumulates. The chronic stage of osteomyelitis is characterized by subsidence of symptoms, after which relapses occur. The remission stage can last from 2-3 weeks to whole years. Predominantly purulent discharge from the fistula is not observed. As for relapses, their course is similar to the signs of acute osteomyelitis in children, but they are less pronounced. Most often, a relapse of the described disease occurs due to the closure of the fistula, as a result of which purulent discharge accumulates inside.

Diagnostics

When there are suspicions that epiphyseal osteomyelitis is developing in children, it is important to contact a medical institution, where the doctor will first conduct a survey. Then the following diagnostic methods are prescribed:

general examination of urinary fluid and blood;
biopsy;
radiography;
fistulography, if a small patient develops fistulas;
CT scan.

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How does the treatment work?

When osteomyelitis in children has been diagnosed, treatment begins. Its initial stages are aimed at using conservative methods. They resort to the help of antibacterial drugs, mainly from the penicillin group. The duration of treatment is determined by the attending doctor depending on the severity of the disease. Most often, the course of therapy is at least 3 months. In addition to antibiotics, the little patient is prescribed immunoglobulins, vitamin-mineral complexes, and medications that have an anti-inflammatory effect. Sometimes they resort to physiotherapy and massage.

If conservative therapy methods do not lead to the desired effect, surgical intervention is prescribed. During the operation, the surgeon opens the abscess and rinses the canal of pus. Mostly, surgery takes no more than half an hour. Before him, they resort to local anesthesia. At the end of the operation, it may be necessary to install a drainage, which allows fluid to drain out.

Are there complications?

Often after treatment for osteomyelitis, young patients develop the following serious consequences:

The consequence of the disease may be poor posture in the child.

bone tissue defects;
disorders of the joints;
dislocations;
arthritis;
poor posture;
spinal cord pinching.

The disease is not contagious, but if osteomyelitis of the lower jaw has been diagnosed in children, it can lead to meningitis, which has serious complications for the entire body. When the disease is localized in the leg, its advanced stage can contribute to the child’s disability.

Prevention

In order to prevent the development of diaphyseal or epiphyseal osteomyelitis in young patients, it is important for parents to protect the child from various injuries and damage to the skin. In addition, you should create a schedule of activity and rest, and monitor a sufficient amount of sleep. You will also need to monitor your diet and exclude fatty, fried, and excessively salty foods from your diet. In the autumn and spring, doctors recommend giving children vitamin and mineral complexes, which can be purchased at pharmacy chains. In addition, you will need to systematically undergo medical examinations with your child, which will allow you to identify possible pathologies in the early stages, which will make it possible to treat the disease in a timely manner and prevent the development of complications.

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The information on the portal is provided for general information. For advice and treatment, contact a specialist.

Osteomyelitis in children

Osteomyelitis in children can cause permanent disability. Early diagnosis, as well as timely conservative and surgical treatment of osteomyelitis in children even before the infection spreads, allows one to avoid severe consequences. Damage to the growth plates of bones and the synovial membrane of joints is especially dangerous.

Causes of osteomyelitis

Acute infectious bone lesions are most often of bacterial origin. In all age groups, including newborns, the main pathogen is Staphylococcus aureus. In newborns, group B streptococci and gram-negative intestinal flora are also often cultured. Group A streptococci are the second most common, but they account for less than 10% of cases. After 6 years of age, the causative agent of osteomyelitis in children in most cases is S. aureus, streptococci or Pseudomonas aeruginosa. Infection with Pseudomonas almost always occurs through puncture wounds of the foot and direct penetration of bacteria from wet shoe insoles into the bone or cartilage, leading to the development of osteochondritis.

With penetrating wounds, infection with atypical mycobacteria is also possible. Fungal infection of bones usually develops when pathogens disseminate from other sites. Bacteremia in newborns with an indwelling vascular catheter is sometimes complicated by osteomyelitis.

Microbial etiology is confirmed in approximately 3/4 of cases of osteomyelitis in children. The small number of bacteria cultured may be due to prior use of antibiotics and the inhibitory effect of pus on the growth of microorganisms.

Prevalence

Osteomyelitis most often develops in young children. Thus, 50% of all cases of arthritis are registered in children under 2 years of age and 3/4 of cases in children under 5 years of age. In boys, bone infections occur 2 times more often than in girls, which can be explained by their more active behavior, which predisposes them to injuries. There are no racial differences in this regard.

Most bone infections in children are hematogenous in origin. Osteomyelitis in children in approximately a third of cases is preceded by minor closed injuries. Infection can occur from penetrating wounds or procedures such as arthroscopy, joint replacement, intra-articular corticosteroids, or orthopedic surgery, although this is rare. A decrease in the body's resistance also contributes to bone infection.

Pathogenesis

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.

Symptoms of osteomyelitis in children

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.

Redness and swelling of the skin over the site of infection in purulent arthritis occurs earlier than in osteomyelitis, since the membrane of the joint is usually located more superficially than the metaphysis. The exception is purulent arthritis of the hip joint, since this joint is located deeper. Local swelling and redness may indicate the spread of infection from the metaphysis to the subperiosteal space and reflect a secondary inflammatory reaction of the soft tissues.

Osteomyelitis in children mainly affects long bones. The femur and tibia are affected with equal frequency, and osteomyelitis in both accounts for almost 50% of all cases. The bones of the upper extremities are affected in approximately 2/4 of all cases of osteomyelitis.

Usually only one bone is affected. Multiple bone or joint lesions are observed in less than 10% of cases. An important exception is gonococcal infection and osteomyelitis in newborns, in which two or more bones are affected in almost 50% of cases.

Diagnosis of osteomyelitis

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.

Survey radiography. In the first 72 hours after the onset of symptoms of osteomyelitis in children, signs of deep tissue edema can be detected on a plain radiograph of the affected limb. Osteolytic lesions are revealed on radiographs only when 30-50% of the bone matrix is destroyed. In long tubular bones, such lesions are detected on the 7-14th day after the onset of the infectious process. In other bones they are detected later.

CT scanning for osteomyelitis in children can identify bone and soft tissue abnormalities and is ideal for detecting soft tissue gas. MRI is better than other radiation methods in identifying abscesses and allowing one to distinguish between infectious processes in bones and soft tissues. Using MRI, the localization of pus in the subperiosteal space and necrotic tissue in the bone marrow and metaphysis is clarified, which is extremely important for surgical intervention. In acute osteomyelitis, purulent contents and swelling appear as dark areas; The signal intensity on T1-weighted imaging is attenuated and the fat produces a bright spot. With T2-weighted imaging the picture is reversed. The signal from adipose tissue can be attenuated using appropriate techniques, resulting in a clearer image. The T2-weighted plane shows high signal intensity from cellulite and fistulas.

MRI data in acute osteomyelitis in children have no less prognostic value than the results of radionuclide scintigraphy. MRI is especially indicated for vertebral osteomyelitis and inflammation of the intervertebral discs, as it clearly delineates the vertebral bodies and cartilaginous discs.

Radionuclide studies in osteomyelitis in children. MRI data can be supplemented by the results of radionuclide scintigraphy, especially if multiple lesions are suspected. For this, it is best to use 99Tc, which accumulates in areas of increased bone tissue metabolism (three-phase scintigraphy). In the focus of osteomyelitis, blood supply and activity of osteoblasts increase, which causes increased accumulation of Tc. In the first (5-10 min) and second (2-4 h) phases, this can be observed in areas of any inflammation and increased blood flow, but with osteomyelitis, increased accumulation of 99Tc also occurs in the third phase (24 h). In hematogenous osteomyelitis, the method of three-phase scintigraphy with Tc has high sensitivity (84-100%) and specificity (70-96%), making it possible to detect the pathological process already after the first symptoms. In newborns, due to insufficient bone mineralization, the sensitivity of this method is much lower. Its advantages include the ability to do without sedatives, repeatedly obtain images of the entire skeletal system after one injection of radionuclide, and the low cost of the study.

Osteomyelitis in children should be distinguished from accidental and intentional injury. Bone or joint pain is often an early symptom of leukemia in children. Neuroblastoma with bone damage can also be mistaken for osteomyelitis in children. With a primary bone tumor, fever and other general signs of osteomyelitis are usually absent. Chronic recurrent multifocal osteomyelitis in children and SAPHO syndrome (Synovitis - arthritis, Acne - acne, Pustulosis - pustular eruptions, Hyperostosis - hyperostosis and Osteitis - osteomyelitis) are rare and are characterized by repeated inflammation of bones and joints and various skin manifestations - pustular eruptions, psoriasis, acne, neutrophilic dermatosis (Sweet's syndrome) and pyoderma gangrenosum.

Treatment of osteomyelitis in children

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 pomg/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 - H. 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.

Special cases of osteomyelitis in children require deviations from the above rules of thumb. In patients with sickle cell anemia, the causative agent of osteomyelitis is usually gram-negative intestinal flora. In addition to antistaphylococcal agents, broad-spectrum cephalosporins such as cefotaxime or ceftriaxone are used. If you are allergic to them, clindamycin can be administered intravenously. Clindamycin not only has high antistaphylococcal activity, but also acts on anaerobic flora. It is effective for infections caused by penetrating wounds or open fractures. Clindamycin and vancomycin can be used as alternatives for infections caused by methicillin-resistant S. aureus. In patients with immunodeficiency, combination therapy is usually used: vacomycin with ceftazidime or piperacillin/clavulanate with aminoglycosides.

After determining the nature of the causative agent of osteomyelitis in children, antibiotics are changed if necessary. If the pathogen remains unknown, but the patient's condition improves, treatment is continued with the same antibiotics. If the patient’s condition does not improve, a repeat puncture or biopsy is performed and the possibility of a non-infectious disease is considered.

The duration of the course of antibiotics for osteomyelitis in children depends on the nature of the pathogen and the clinical course of the disease. For infections caused by S. Aureus or gram-negative flora, the minimum duration of the course (if signs and symptoms disappear on the 5-7th day and the ESR returns to normal) is 21 days. However, a 4-6 week course may be required. When infected with group A streptococci, S. pneumoniae or H. influenzae, antibiotics are administered for at least a day, based on the same criteria. After intensive curettage of the affected tissue in patients with pseudomonas osteochondritis, it is enough to administer antibiotics for only 7 days. Patients with immunodeficiency, as well as those with mycobacterial or fungal infections, usually require longer treatment.

After about a week, when the patient’s condition has stabilized, you can switch to oral antibiotics. In these cases, the dose of ß-lactam antibiotics for staphylococcal or streptococcal infections should be two or three times higher than for other infections. The adequacy of the dose can be judged by the maximum bactericidal serum titer, or Schlichter titer, one minute after taking the suspension or one minute after taking the capsule or tablet. The required bactericidal serum titer should not be less than 1:8. Taking antibiotics orally reduces the risk of infection with normal microflora of the oral cavity, which is possible with long-term intravenous therapy, is more convenient for patients and allows you to continue treatment at home. At home, for osteomyelitis in children, intravenous antibiotics can be continued (through a central venous catheter).

Randomized prospective studies of different methods of surgical treatment of osteomyelitis in children have not been conducted. If pus is detected in punctates of the subperiosteal space or metaphysis, surgical drainage of the lesion is indicated. Surgical intervention is often carried out after a penetrating wound, as well as in cases of possible entry of foreign bodies.

Reasons for the development of the disease

Classification of the disease

Children's osteomyelitis is divided into 2 types depending on the routes of infection into the body:

Bacteria can enter the bone canal through the blood.

. Damage to the bones of the legs and other areas occurs due to the entry of bacteria through the blood.
Non-hematogenous. Infection is observed due to open wounds and inflammatory processes in the soft tissues adjacent to the bones. This type of osteomyelitis is also called secondary.

Classification of the disease involves its division based on the reasons that provoke the occurrence of infection:

Specific form. The disease develops due to the penetration of pathogenic bacteria into the body.
Non-specific. Osteomyelitis appears due to previously diagnosed tuberculosis and syphilis.

What symptoms does the pathology have?

Acute stage of osteomyelitis in children

The classification of the clinical picture is related to the stage of the disease, causes and age of the child. The acute degree of the disease develops quickly and has 3 forms:

In the septicopyemic form of the disease, the child experiences chills and fever.

Local. Inflammation affects only tissue and bones. Most often, the child’s general health remains normal.
Septic-pyemic. The little person has the following symptoms:
- increased body temperature;
- chills;
- headaches;
- attacks of nausea and vomiting;
- fainting;
- impaired coordination of movements when the inflammatory process affects the legs or arms;
- swelling;
- poor blood clotting;
- hormonal imbalance;
- deterioration of kidney and liver activity.
Toxic. This form is characterized by blood poisoning, as a result of which young patients complain of the following symptoms:
- vomit;
- increase in temperature;
- convulsions;
- excessive decrease in blood pressure;
- heart failure in the acute stage.

In newborn children, the symptoms are less pronounced than in older young patients. Mostly parents only note a deterioration in their general health.

Chronic degree

After the disease becomes chronic, the child may still feel unwell.

In the area of the source of infection, fistulas appear, inside of which pus accumulates. Symptoms subside, followed by relapses. The remission stage can last from 2-3 weeks to whole years. Predominantly purulent discharge from the fistula is not observed. As for relapses, their course is similar to the signs of acute osteomyelitis in children, but they are less pronounced. Most often, a relapse of the described disease occurs due to the closure of the fistula, as a result of which purulent discharge accumulates inside.

Diagnostics

general examination of urinary fluid and blood;
biopsy;
radiography;
fistulography, if a small patient develops fistulas;
CT scan.

How does the treatment work?

The pathology can be treated for a long time with antibacterial drugs.

When osteomyelitis in children has been diagnosed, treatment begins. Its initial stages are aimed at using conservative methods. They resort to help, mainly from the group of penicillins. The duration of treatment is determined by the attending doctor depending on the severity of the disease. Most often, the course of therapy is at least 3 months. In addition to antibiotics, the little patient is prescribed immunoglobulins, vitamin-mineral complexes, and medications that have an anti-inflammatory effect. Sometimes they resort to physiotherapy and massage.

Are there complications?

Often after treatment for osteomyelitis, young patients develop the following serious consequences:

The consequence of the disease may be poor posture in the child.

bone tissue defects;
disorders of the joints;
dislocations;
arthritis;
poor posture;
spinal cord pinching.

The disease is not contagious, but if osteomyelitis of the lower jaw has been diagnosed in children, it can lead to meningitis, which has serious complications for the entire body. When the disease is localized in the leg, its advanced stage can contribute to the child’s disability.

Prevention

Osteomyelitis in children develops more often due to the fact that children have a larger number of bone zones containing bone marrow, and also due to the fact that the bones have an active blood supply for full active growth. The most susceptible to damage are the shoulder and lower leg, thigh, jaw, and vertebrae. With the development of osteomyelitis, a purulent process occurs with destruction (necrosis) of bone tissue, damage to the bone marrow and surrounding soft tissues. The causes of development are infection with microbes capable of forming pus. The process can have an acute and chronic course, with the latter causing severe skeletal deformities with bone growth problems.

For reasons, osteomyelitis can be nonspecific - it is a lesion by microbes of the opportunistic and pathogenic group (staphylococci, streptococci, Proteus, etc.). In case of specific damage, the causes of purulent straightening of the bones will be tuberculosis and brucellosis microbes.

The infection can penetrate the bone area hematogenously, with the bloodstream the pathogens settle in the bone tissue. There may also be other ways - with wounds, injuries, the transition of inflammation from the tissues surrounding the bones.

Osteomyelitis occurs more often in boys, due to their greater tendency to injury; odontogenic osteomyelitis can become a separate option - the transfer of infection to the jaw bones from the cavity of carious teeth.

Symptoms

Manifestations of osteomyelitis are quite obvious, especially in children after 1-2 years. They manifest themselves acutely, with chills and high fever reaching critical levels, increased heart rate, severe weakness with pallor, lethargy and malaise. Acute pain occurs in the joint and limb affected by the process; older children may notice pain inside the bone, which gradually intensifies and prevents them from making habitual movements. Over the course of a couple of days, pronounced swelling and local redness occur at the site of the lesion, an abscess is formed, which can literally disappear after a few days with a decrease in pain, which leads to increased swelling of the redness. The mobility of the affected area is sharply limited, the child spares the area of edema. At the site where the pus breaks out, a fistula may remain, a duct through which pus flows out or the wound closes. If the acute process is not treated, the purulent focus remains inside the bone and tissues, leading to slow destruction of the bone and deformation of the limb, tissues, pathological fractures and tissue disfigurement.

Diagnosis of osteomyelitis in a child

The basis of diagnosis is typical complaints and the clinical picture; it is necessary to confirm the source of infection using tests. The blood test will reveal leukocytosis as a sign of purulent infection, and the biochemical blood test will change. When inoculating the discharge or blood, the pathogen that gives rise to a purulent focus will be identified. It is important to take an X-ray of the bones to identify areas of bone thinning and destruction, and thickening of the periosteum. It is often necessary to distinguish manifestations of osteomyelitis from cancerous bone lesions, the development of rheumatism, and purulent arthritis. For these purposes, CT and MRI of the affected areas and specific studies can be used.

Complications

Osteomyelitis is dangerous due to complications in the form of joint instability and bone deformations, pathological dislocations, changes in bone growth processes, and arthritis. With improper treatment or its absence, the process becomes chronic with progressive skeletal deformation. Damage to the spine can lead to profound disability with immobilization; damage to the jaws threatens changes in the face and the spread of infection to the cranial cavity. Damage to the hip leads to immobility.

Treatment

What can you do

Osteomyelitis is a dangerous purulent disease that has serious complications; self-medication is unacceptable. At the first symptoms, you need to immediately consult a doctor.

What does a doctor do

It is important to simultaneously influence both the pathogen and the child’s body in order to stimulate it to fight infection and restore bone tissue. All activities are carried out only in the hospital. Immune treatment is carried out, immunity is stimulated, as well as the introduction of vitamins and antibiotics to which the pathogen is sensitive. Antibiotics are administered in large doses, intravenously or into the muscle, in combination with drugs to protect the intestinal microflora. Local decompression is also indicated - pressure on the bone marrow and its vessels is removed, pathological tissue is eliminated. The affected area is fixed in a special way, special periostomy operations are performed - the periosteum is dissected and separated from the bone, the focus of suppuration is drained with the removal of dying tissue and pus. After the purulent focus is eliminated, the condition is normalized, further rehabilitation methods are necessary - physical therapy and massage, sanitation of foci of infection, exposure to climatotherapy and hydrotherapy (sanatorium). Then twice a year they are treated with immunostimulating drugs, antiallergic and anti-inflammatory, as well as physical therapy to stimulate bone growth and restore tissue integrity. This includes laser therapy, magnetotherapy, vitamins, electrophoresis with antibiotics. It is important to regularly conduct x-rays to monitor the healing for three years; rehabilitation is required within the framework of sanatoriums.

Prevention

The basis of prevention is a healthy lifestyle and treatment of foci of chronic infection, prevention of injuries, good nutrition and strengthening the immune system.

Osteomyelitis is a disease caused by infection. Manifests itself in the form of inflammation. The lower legs, thighs, humeri, vertebrae and jaw joints are most often affected. Osteomyelitis is a purulent-necrotic process that develops in the bone marrow and surrounding soft tissues. Typically, the disease occurs in boys (2 times more often than in girls) due to high mobility, fights, injuries, and falls.

Osteomyelitis in children (photos of the external manifestations of the disease can be seen in this article) is a dangerous disease. The disease affects the bone marrow. The infection is concentrated directly in the bones and is almost invisible externally. Therefore, diagnosing the disease in children at an early stage is quite difficult, since they cannot accurately describe the symptoms and sensations. If acute osteomyelitis in children is not treated on time, deformation of the child’s skeleton may occur. This disease can cause disability and serious consequences.

Forms of osteomyelitis

Osteomyelitis is divided into two forms. The first one is specific. This is a secondary disease that is caused by bacteria after tuberculosis, syphilis or brucellosis. But it is rare in children. The second form is nonspecific. Occurs due to purulent cocci and microbes.

Kinds

Osteomyelitis in a child can be of several types:

Causes of osteomyelitis

The main causes of osteomyelitis in children are purulent infections and injuries. The disease is often caused by:

otitis;
furunculosis;
pyelonephritis;
impetigo;
burns;
fractures;
wounds.

Staphylococcus aureus is a common causative agent of the disease. It is found in osteomyelitis in eighty percent of cases. In the remaining twenty percent, patients are diagnosed with various bacilli (Pfeiffer's, intestinal), salmonella and streptococcus. Acute odontogenic osteomyelitis begins due to teeth affected by caries. The culprit is pathogenic bacterial flora located in the pulp and periodontium.

Osteomyelitis in children: symptoms of the disease

Main symptoms of osteomyelitis:

chills;
arthritis of the limbs;
swelling and redness of the affected areas;
weakness and lethargy;
rapid pulse;
increasing bone pain;
high leukocytosis, positive blood culture and leukopenia;
Changes may not initially be visible on x-rays; they appear later.

Symptoms of osteomyelitis depend on the area of bone affected and the age of the child. Newborns are lethargic, nervous, suffer from lack of appetite, and have a high temperature. Sometimes vomiting and diarrhea occur.

If you watch a child, you can see how the baby protects the limb (does not touch objects with it and tries not to move). The affected area may turn red, and sometimes swelling appears. After a few days they increase in size. If treatment is not started in time, purulent metastases will begin to multiply.

Older children experience the same symptoms, but they are more pronounced. Inflammation takes longer to develop, and redness and swelling can only be seen a week after the onset of the disease.

With odontogenic osteomyelitis, pus leaks from the dental canals and gums. The teeth that are located next to the patient are too mobile. Begins:

swelling of the face;
the skin and mucous membranes turn pale;
temperature rises;
chills and general weakness occur;
babies may experience seizures;
vomit;
indigestion.

This occurs due to severe intoxication of the body. Primary chronic osteomyelitis in a child manifests itself with vague symptoms. There are minor pains, but they do not have a clear localization.

In the secondary chronic form, remission and exacerbation alternate (sometimes for years). In the first case, the child has no complaints, in the second, pain on palpation and fever begin. Fistulas may open and discharge pus. This form of the disease affects the liver, heart and kidneys.

Diagnostics

Diagnosis of the disease is complicated, since hematogenous osteomyelitis in children can be confused with rheumatism, purulent arthritis or Ewing's sarcoma, the symptoms of which are similar. Sometimes, at the first sign, a malignant infection is suspected.

Treatment methods

Treatment of osteomyelitis in children is carried out using methods that affect the microorganisms that caused the disease and directly on the affected bones:

Treatment

Osteomyelitis in a child begins with treatment with antibiotics. They are important in the early stages of the disease to stop the inflammatory process. Mostly drugs containing penicillin are prescribed. The course of treatment is from one to three months. At the same time, medications are prescribed for thrush, since antibiotics disrupt the body's microflora and this disease can occur.

Sometimes surgery is necessary. The doctor opens the abscesses and flushes out the pus from the canals. During operations, local anesthesia is used. For odontogenic osteomyelitis, the main treatment is surgery. During it, the diseased tooth is removed, abscesses are opened, and wounds are drained. Appointed:

detoxification therapy;
preparations containing calcium;
antihistamines;
antibiotics;
vitamin complexes;
nonspecific immunomodulators;
diet (dairy and plant foods and drinking plenty of water).

Osteomyelitis in a child continues to be treated after hospitalization. Massage and physical therapy are provided on an outpatient basis. The affected areas are sanitized and balneotherapy is carried out. The child undergoes inpatient treatment regularly twice a year. During this period, desensitizing, laser, magnetic, and vitamin therapy are carried out. Immunomodulators are used. Electrophoresis and antibiotics are prescribed. X-rays are taken every six months, then for monitoring once every year for three years. The child may be sent to sanatorium-resort treatment.

Prevention

To prevent the development of this disease, you need:

maintain proper wakefulness and sleep patterns;
adhere to a healthy lifestyle;
do not be nervous;
Healthy food;
strengthen immunity;
undergo regular medical examination.

For all kinds of ailments, you should go to the clinic and not self-medicate. Eighty percent of all diseases can be cured at an early stage, the main thing is to make a diagnosis in time.

Osteomyelitis is a serious bone disease, when all structures - themselves, the bone marrow, and the periosteum - are affected by infection, and purulent-necrotic formations appear in them and in the surrounding soft tissues.

Osteomyelitis in a child is most often observed before the age of one year.

The infection begins at the ends of long bones, since it is there that the arteries form loops with slow blood flow - an ideal environment for the development and activity of bacteria brought along with the blood.

Causes of osteomyelitis in children

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.

The main carriers of the disease through the blood are staphylococci and streptococci.

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.

An umbilical wound is dangerous because it can cause osteomyelitis in a child.

This bone disease occurs 2 times more often in boys, since they are more active in games and everyday life than girls, which leads to frequent injuries.

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

Symptoms of osteomyelitis

In the first days after infection there are no signs of the disease. Subsequently, all its manifestations depend on how old the patient is, what kind of immunity he has, what type of bacteria the infection occurred, as well as on the location of the affected bone and the degree of its involvement in the inflammatory process.

Signs of osteomyelitis:

very high temperature;
chills;
cardiopalmus;
severe pain in a certain area of the bone;
Swelling and redness of the soft tissues begin around the diseased bone.

With post-traumatic osteomyelitis in children, there are the following symptoms:

wound or injury accompanied by suppuration of the wound surface;
swelling, redness of soft tissues;
severe pain in the damaged area;
temperature.

Acute manifestations of the disease can become chronic over time, when signs of intoxication disappear, the temperature subsides, and the pain is not so intense. The source of inflammation around the bone becomes covered with purulent fistulas, which indicate that the disease has entered a chronic stage, when periods of decline and exacerbation will alternate.

Any wound on a child’s body can lead to post-traumatic osteomyelitis

Relapse begins at the moment when the fistulas close, pus is no longer released, but goes into the cavity that has formed around the infected bone.

In newborns, the disease primarily affects cartilage tissue.

It is very difficult to diagnose this infection, since the child cannot explain what and how it hurts, and an x-ray cannot show any pathologies, because they appear at later stages.

What you need to pay attention to:

the child worries for no reason;
pale skin;
refuses to eat;
temperature;
the child is lethargic;
sometimes vomiting and diarrhea begin;
the child protects the limb and screams in pain if it is touched;
the skin around the affected area is hyperemic, and within a week the hyperemia spreads to the entire limb;
a blood test shows leukocytosis, a blood culture (culture of microbes) is isolated from the blood;

If parents are careless about the child’s health and do not consult a doctor in a timely manner, then ulcers and fistulas can spread throughout the baby’s entire body.

Treatment method for osteomyelitis

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:

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.
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.
Local treatment of the diseased area of the limb is carried out using physiotherapy and fixation with a plaster splint.
The patient’s immunity is increased by various methods, with the help of vitamins and immune stimulants.
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.

If left untreated, the entire musculoskeletal and musculoskeletal system will be affected by infection. The bacteria spread throughout the body through the bloodstream and attack different areas of the bones.

Over time, irreversible changes will occur in all internal organs. The consequences of osteomyelitis in newborns are especially terrible - the young body will not be able to defeat such strong bacteria, which will lead to surgical intervention or disability.

Even surgery with drainage of purulent foci and intraosseous rinsing with antibiotics cannot always save the limb.

Chronic osteomyelitis can only be cured with surgery. It should be noted that in such diseases it is extremely rarely fatal.

Preventive actions

To prevent infection, you should follow simple rules:

All wounds, cuts, and open fractures must be treated with alcohol or another antiseptic.
Do not touch open wound surfaces with dirty hands.
For any injuries that involve an open wound, consult a doctor.
All foci of chronic infection must undergo regular thorough sanitation.
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.

It is important to always properly treat your child's wounds.

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.

Osteomyelitis is a purulent-necrotic pathology that develops in bones, soft tissues, and bone marrow. The disease is caused by bacteria that produce pus. Osteomyelitis is most common in children. Its chronic form can cause severe bone deformation. The pathological process usually affects the thigh, lower leg, foot, and spine.

Osteomyelitis in children - external manifestations

Classification

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.

According to the path of penetration of microorganisms, pathology is divided into:

Primary, hematogenous osteomyelitis, in which damage occurs as a result of bacteria entering the circulatory system;
Secondary, non-hematogenous, which can occur as a result of trauma if the surrounding tissue is damaged.

According to clinical manifestations there are:

Spicy;
Chronic osteomyelitis.

Causes

Usually the causes of the disease are associated with the penetration of infection into the bone marrow canal. Metaepiphyseal osteomyelitis in children occurs due to infection with Staphylococcus aureus.

If the disease is characterized by multiple purulent foci, then its causative agent is an anaerobic infection. The most common causes of the disease include:

An infectious focus present in the body, which is the source of the pathogen entering the bone marrow. This could be otitis media, caries, tonsillitis, enterocolitis;
A congenital infectious process that is caused by intrauterine damage or penetration of the pathogen during childbirth;
Reduced immune activity. This condition can be acquired or congenital. It is provoked by oncology, brucellosis, tuberculosis;
Slow blood flow, which occurs as a result of hypothermia, inflammation of soft tissue;
Trauma causing post-traumatic osteomyelitis as a result of hematoma, swelling, impaired bone blood flow, and infectious process.

Interesting!

Epiphyseal osteomyelitis in children occurs due to the structural features of the vessels feeding the bone.

Reasons for the development of osteomyelitis in children

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 produces more pronounced symptoms than in older children, who often experience only a slight deterioration in general well-being.

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.

Relapses of the pathology are similar to the acute form, but have a less pronounced manifestation. Typically, an exacerbation occurs as a result of a closed fistula. Because of what the purulent process accumulates.

Diagnostics

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.

Diagnosis of osteomyelitis in children

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.

Children suffering from osteomyelitis are subject to mandatory hospitalization.

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.

Features of treatment of osteomyelitis in children

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.

The acute form of bone osteomyelitis becomes chronic, in which, if a pathology of the femur occurs, the baby loses the ability to move. It is also possible to develop oncology and pinched spinal cord.

Osteomyelitis of the leg bone in a child is a serious problem. Early diagnosis and adequate treatment are the key to complete recovery. If you do not consult a doctor in a timely manner, serious complications can develop, including death.

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:

Epiphyseal parts. These are the ends of bones that have anatomical structures to connect to other bones, form joints, and attach ligaments and muscles.
Diaphyseal part. This is the middle part of the bone that contains the channel for the bone marrow.
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:

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.
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.
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.
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.
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:

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

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.
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.
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.
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.