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Osteomyelitis should be considered in patients who have bony tenderness and whose history, physical examination, and x-ray findings are suggestive, or if the evaluation does not provide another diagnosis. Trauma may be a precipitating factor of osteomyelitis, but young children are prone to frequent minor trauma in the lower extremities from their normal activities. Osteomyelitis is 2.5 times more common in males than in females.


  • Osteomyelitis may also result from an infection in an adjacent soft tissue, the infection spreads to the bone after several days or weeks. Such an infection may start in an area damaged by an injury, radiation therapy, or cancer, or in a skin ulcer caused by poor circulation or diabetes.
  • Several bacterial that may causes of acute and direct osteomyelitis such as including S aureus, Enterobacter species, and group A and B Streptococcus species, Pseudomonas species, Salmonellae species.


  • Bone pain
  • Fever
  • Smaller children and infants may have vague symptoms of irritability and poor feeding or may appear toxic or septic.


  • Bone tenderness +++ in toddlers and young children. The older the patient, the easier to detect the exact site of tenderness on examination.
  • Limp or refusal to walk +++
  • Fever +++
  • Overlying erythema
  • Joint motion can be limited from the local muscle spasm caused by inflammation.


  • For the treatment of chronic infection, In which surgical removal of dead bone tissue is usually necessary and the open space left by the removed bone tissue may be filled with bone graft or by packing material to promote the growth of new bone tissue.
  • If a fungal infection is identified or suspected, then antifungal drugs are required for several months. If the infection is detected at an early stage, surgery is usually not necessary. Occasionally, however, an abscess forms, which may be drsained surgically.
  • An artificial joint that has an infection around it is removed and replaced. Antibiotics may be given several weeks before surgery to try to eradicate the infection, so that the contaminated artificial joint can be removed and a new one can be implanted at the same time.

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