Subacute hematogenous osteomyelitis is due to organisms being less virulent or patients more resistant or both.
Anatomical Classification of Subacute hematogenous osteomyelitis
- Epiphyseal
- Metaphyseal
- With cortical erosion
- Without cortical erosion
- Diaphyseal
- Cortical
- Periosteal
- 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
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
