Osteomyelitis is an infection that affects the bone tissue via hematogenous dissemination, direct post-traumatic or post-surgical inoculation, or a contiguous local infection, such as cellulitis or sinusitis. It is preferentially localized in the metaphyseal region of long bones. Short bones are more rarely affected. Sternal involvement is observed in about 1% of all pediatric osteomyelitis cases. Initial symptoms are often nonspecific, thus resulting in delayed diagnosis. Once the infection is established, symptoms of local inflammation appear. The treatment consists of a targeted antibiotic therapy depending on the child’s age and germs responsible for the infection.
Key Words
Sternal osteomyelitis, pediatrics, primary infection
What is already known about the topic?
- Osteomyelitis is an infection that mainly affects the metaphysis of long bones where a slow capillary blood flow promotes the implantation of pathogens.
- Bone scan sensitivity for osteomyelitis is high, around 95%. The hypercaptation of the tracer can be demonstrated several days before a periosteal reaction, with osteolysis visible on X-ray.
- Osteomyelitis requires long treatment times, mostly ranging between 4 and 6 weeks.
What does this article bring up for us?
- Although short bones are more rarely affected, it is necessary to consider this infection in the differential diagnosis of a mass localized next to a bone.
- Scintigraphic sensitivity is lower in neonates and infants. The absence of hyperfixation on scintigraphy does thus not exclude osteomyelitis in young children
. - Experts increasingly tend to recommend a rapid relay by an oral treatment when the evolution is favorable under intravenous antibiotic therapy.