May 30, 2024

Subacute hematogenous osteomyelitis is due to organisms being less virulent or patients more resistant or both.

Anatomical Classification of Subacute hematogenous osteomyelitis

  1. Epiphyseal
  2. Metaphyseal
    1. With cortical erosion
    2. Without cortical erosion
  3. Diaphyseal
    1. Cortical
    2. Periosteal
  4. Vertebral

Pathology

The well-defined cavity in cancellous bone – usually in tibial metaphysics containing glairy seropurulent fluid (rarely pus)

The cavity is lined by granulation tissue containing a mixture of acute and chronic inflammatory cells

Clinical Features

May limb, slight swelling, muscle wasting, and local tenderness

Normal temperature

Subacute hematogenous osteomyelitis

Imaging

Circumscribed, round to oval radiolucency cavity

1-2 cm in diameter

Sometimes a cavity is surrounded by a halo of sclerosis [ Brodie’s abscess]

Diagnosis: Plain X-ray is sufficient

Treatment Options

Conservative:

If the diagnosis is not in doubt

Immobilization and antibiotics (flucloxacillin + fusidic acid) for 4-5 days

then orally for another 6 weeks

If the diagnosis is in doubt: Open biopsy and lesion is curettage

Curettage is Indicated:-

X-ray shows no healing after conservative treatment followed by antibiotics

Example: Brodie’s abscess

Garre’s Sclerosing Osteomyelitis

Chronic form of osteomyelitis characterized by sclerosing, nonsuppurative and cortical thickening

It has a symmetrical thickness of bone and irregularity but with a conspicuous absence of abscess and sequestra

(Brodie’s abscess has abscess but no sequestra)

Radiological investigation

  • Shows increase bone density and cortical thickening
  • In some cases, the marrow cavity is completely obliterated

The low-grade anaerobic infection could be caused

Treatment:

Guttering the bone or drilling multiple holes may alleviate pain

Should be differentiated from Paget and osteoid osteoma

See also: Chronic Osteomyelitis

See also: Acute Hematogenous Osteomyelitis

See also: Multifocal Non-suppurative Osteomyelitis and Caffey’s Disease