Abstract: In eight children with primary subacute osteomyelitis of a femoral or tibial epiphysis, the only complaints were pain and limp. Plain roentgenograms and tomograms showed a well defined lytic lesion in the epiphysis and no evidence of any connection to the metaphysis. Although the bone of the epiphysis was involved in every instance, and the lesion extended to the articular cartilage in most patients, the cartilage itself was not damaged. When the lesions were curetted, six were sterile on routine and anaerobic cultures and on culture for tuberculous and fungal organisms, and Staphylococcus was grown from the other two. In every case the curetted tissue had the characteristic histological appearence of osteomyelitis. All patients were treated with oxacillin and recovered completely. Postoperative roentgenograms showed complete healing with no evidence of damage to the physis or the joint after follow-up of two to eight years.

Abstract: Osteomyelitis was induced in the tibiae of rabbits by injecting a suspension of Staphylococcus aureus and sodium tetradecylsulphate, a sclerosing agent. These rabbits were then divided into two groups: one group remained untreated and the other was fed a diet containing sodium salicylate. Two and four weeks after induction of osteomyelitis the tibiae taken from untreated rabbits with osteomyelitis and incubated in vitro released significantly more prostaglandin E and F than the control uninjected or uninfected tibiae. Tibiae taken from rabbits treated with sodium salicylate showed minimal radiographic changes and a significantly decreased release of prostaglandin E and F compared to the untreated rabbits. Prostaglandins are known to be potent bone resorbing agents and the results of this study suggest that they may also be involved in the destruction of bone which is characteristic of osteomyelitis. The treatment of rabbits with osteomyelitis using anti-inflammatory drugs, which block synthesis of prostaglandins, in addition to antibiotics, may prevent the destruction of bone and possible sequestration thereby decreasing the risk of chronic disease.

Abstract: Six different conditions of non-infective bone and joint pathology have been seen amongst 67 patients with diabetic neuropathy. The characteristics of each are described. Not all the conditions require treatment but they should be differentiated from osteomyelitis. Charcot osteoarthropathy is the most common condition seen but spontaneous fractures and dislocations generally present greater therapeutic problems. The aim of treatment should be to obtain a stable foot in which there is no undue pressure on the skin from a bony prominence.

Abstract: The Huntington fibular transference operation was done in three patients with tibial defects resulting from osteomyelitis and in three patients with infected pseudarthroses. It has proved to be an ideal procedure when the local condition of either skin or bone, or both, is not suitable for conventional bone-grafting operations. The fibula, transferred as a pedicle graft, hypertrophies under weight-bearing stresses, fixing the tibial fragments and stimulating osteogenesis. The procedure is carried out in two stages and bypasses the site of infection. It does not carry the risk of causing a flare-up of infection and it is most suitable for young patients.

Abstract: Twenty-five patients with active, chronic osteomyelitis, resistant to conventional management, were treated with surgical debridement and daily application of electrically activated silver dressings. Sixteen (64%) cases resulted in closed, stable, pain-free wounds, with the remainder resulting in persistent drainage or amputation. Nine of 12 cases complicated by nonunion achieved union. In 13 patients an open-bone graft was performed and silver treatment continued: these tended to remain free of purulent drainage but fared no better than average in the long-term follow-up. The silver anode dressing seems to be an effective aid in the treatment of chronic bone infection when combined with adequate surgical debridement, thereby reducing the need for prolonged systemic antibiotics.

Abstract: Summary: A review was carried out on nine children who were diagnosed and treated for septic arthritis of the glenohumeral joint at the University of California, San Diego affiliated hospitals. Eight of the nine patients were under 18 months of age at the time of diagnosis. Three patients had a history of antecedent trauma, and four had a previous or concurrent source of infection. The longest delay between the onset of symptoms and diagnosis was 30 days with the majority being diagnosed within 4 days of onset. Laboratory findings revealed a mean white blood cell count of 17,400 and a mean temperature of 39.3°C. The sedimentation rate was always greater than 30 mm and averaged nearly 60 mm in these nine patients. Joint cultures were positive for a variety of organisms. Early radiographic findings often demonstrated widening of the joint space. Associated osteomyelitis of the proximal humerus was present in five of nine patients. Once the diagnosis has been established by aspiration, we recommend arthrotomy. Important aspects of the surgery include drainage of the joint and bicipital recess, and drilling of the proximal humeral metaphysis to rule out osteomyelitis or to more adequately decompress the bone.

Abstract: A blow sustained to the head while wrestling may produce frontal osteomyelitis and its complications, Pott's puffy tumor and epidural abscess. The symptoms may be minimal and may be manifested only by a mild headache and occasional stuffy nose. A 16-year-old boy was studied one month after a head injury sustained while wrestling, complaining only of recurrent headaches and fever. A fluctuant mass was found in the midfrontal area. Frontal sinusitis, subperiosteal abscesss epidural abscess, and frontal osteomyelitis were found at surgery. The frontal bone involved by the osteomyelitis was debrided, and the epidural abscess was evacuated.

Abstract: We have discussed 13 patients with Pasteurella multocida infection of the hand, six of whom developed chronic hand impairment as a result of the infection. It is thus apparent that chronic morbidity following Pasteurella infection of the hand is nearly 50 percent. Despite a fairly wide antibiotic susceptibility pattern of this organism, the infection may have long-term consequences such as osteomyelitis, or small joint stiffness due to paraarticular infection. We wish to emphasize the rapid evolution of the clinical picture following inoculation and the need for vigorous antibiotic therapy supplemented by rest, elevation immobilization, and occasional surgical decompression or drainage. At this time, the preferred antibiotic for initial care would appear to be on of the cephalosporins changed to penicillin for the culture-proven infection.

Abstract: METHICILLIN-resistant strains of Staphylococcus aureus were first reported from the United States as early as 1960. However, outbreaks of nosocomial infections caused by these organisms, usually involving adult patients, have only recently been reported. 1,2 Such an outbreak associated with S aureus resistant to methicillin, the cephalosporins, erythromycin, lincomycin, clindamycin, and kanamycin occurred among neonates housed in the intermediate and intensive care nurseries of our city-county hospital during the summer of 1979. The index patient had persistent bacteremia and multiple bone osteomyelitis that were successfully treated with gentamicin and vancomycin. Report of a Case A 1.0-kg male infant was born to an apparently healthy 20-year-old mother. Gestational age was 22 weeks by history and 30 weeks by physical examination. The pregnancy was uncomplicated. Ventilatory support was required for the first two days of life for transient tachypnea of the newborn and apnea. An umbilical arterial catheter (UAC), placed shortly after

Abstract: Six children suffered Salter I fractures of the distal phalanx of a great toe caused by stubbing. The first four children presented with cellulitis and osteomyelitis. The last two were treated promptly with antibiotics, and no infection developed. Analysis of the anatomic relationship of the distal phalanx and nail indicates that these fractures were compound despite the absence of usual clinical signs. Recognition of these occult compound fractures and treatment with antibiotics should prevent infectious complications.

Abstract: The diagnosis of acute osteomyelitis is often very difficult during the first 24 to 48 hours. Bone scanning has been a useful adjunct in this diagnosis by demonstrating increased uptake in the area or areas of involvement. Occasionally the pathological area is "cold" on scanning, which may lead to a misdiagnosis. This paper presents three cases demonstrating this unusual finding.

Abstract: A young woman with a 12-year history of symptoms of osteomyelitis of her spine had been treated for unproven tuberculous disease. During an acute flare-up of her symptoms, bacteriologic proof of Salmonella typhi infection was obtained, and the patient was treated with chloramphenicol and amoxycillin. The case illustrates the difficulties involved in making a radiologic diagnosis and the value of obtaining bacteriologic identification of the organism.

Abstract: Osteomyelitis of maxillofacial bones is difficult to differentiate from the results of trauma or malignancy, yet successful management is dependent upon early diagnosis and appropriate therapy. To determine if gallium-67 could differentiate infection from trauma or malignancy, 61 Tc-99m phosphate scans and 52 gallium-67 scans were made in 42 patients with maxillofacial disease. In all patients, definitive diagnosis was determined by surgery and/or clinical followup. Bone scans were positive in 37 patients. Gallium-67 scans were positive in 16 patients. Subsequent surgery and/or clinical followup demonstrated active osteomyelitis in 15 patients. From the data we conclude that: (a) the addition of Ga-67 scanning to the bone scans in evaluation of maxillofacial disease contributes significantly to differentiating trauma from osteomyelitis; (b) radiographic changes do not accurately reflect bone activity or differentiate osteomyelitis from trauma or malignancy; and (c) reduction in accumulation of gallium-67 in followup scans is a useful indicator for the termination of therapy in osteomyelitis.

Abstract: Two cases of Pasteurella multocida osteomyelitis occurred following dog bit injuries. Difficulties exist in diagnosis and treatment. The role of P Multocida and other dog mouth flora in the pathogenesis of infectious complications following dog bites is discussed. we urge a flexible antimicrobial approach based on culture results.

Abstract: We describe a previously healthy, immunologically normal young girl who presented painless swelling of fingers, a toe, and one knee. Roentgenograms were consistent with osteomyelitis of the phalanges and knee effusion. Rice bodies (corpora oryzoidea) were identified in viscous fluid obtained from the knee during arthroscopy. Culture of this fluid grew an organism initially believed to be a member of the genus Nocardia but which was later presumptively identified as a member of the genus Rhodococcus. The patient was successfully treated with a combination of erythromycin and amoxicillin for a total of 6 months. Previously reported cases of this unusual infection and the microbiological features of the organism are reviewed. The significance of rice bodies found in joint fluid and the therapy of this infection are discussed.

Abstract: Fourteen patients with proven septic arthritis, osteomyelitis or spondylitis were studied retrospectively by both computed tomography (CT) and conventional examinations. CT was performed only when specific problems of diagnosis were unsolved after plain films, standard tomograms or isotope bone scans. In these selected cases, CT was of definite value for: the study of the entire articular surface of bone and periarticular soft tissues; the delineation of extent of medullary and soft-tissue involvement; the demonstration of cavities, serpiginous tracts, sequestra or cloacae in osteomyelitis. It sometimes showed soft-tissue edema or bone destruction not seen on plain films.

Abstract: Analysis of a case of presumed hematogenous septic arthritis and osteomyelitis involving the elbow, distal humerus, and proximal radius and ulna in a leatherback turtle (Dermochelys coriacea) showed the chondro-osseous response to be similar to the diseases in skeletally immature humans and terrestrial mammals (both spontaneous and experimental). This particular reptile has bone that is similar to mammalian bone. The infection had partially destroyed the distal humeral, proximal ulnar and proximal radial joint surfaces and epiphyseal cartilages. The elbow was filled with a fibrovascular pannus that had caused a partial ankylosis of the joint.

Abstract: In past years the clinical and radiologic presentation of true heterotopic bone in the paralyzed patient has been confused with osteomyelitis, neoplasm, trauma, and thrombophlebitis. We reviewed 376 paralyzed patients' roentgenographic files and found 78 patients with soft tissue ossification unassociated with infection, neoplasm, or underlying fractures, which we called true heterotopic bone. From this population the usual spectrum of radiologic findings is described, so that the radiologist may separate roentgenographically a group of patients from other types of ectopic ossification.

Abstract: A eromonas hydrophila , a motile Gram-negative bacterium, has been only rarely reported as the cause of human disease. The organism was previously thought to be an opportunistic pathogen of low virulence often associated with polymicrobic infections and infections in debilitated patients, particularly those with neoplasms. 1 More recent reports describe an increasing incidence of serious diseases resulting from primary infection with A hydrophila . These include septicemia, osteomyelitis, necrotizing myositis, endocarditis, meningitis, and wound infections. 2,3 Although skin and soft-tissue infections caused by Aeromonas sp rank second in frequency only to gastrointestinal tract infections, they are not well recognized and reported in the dermatology literature. Cutaneous manifestations may be accompanied by fever, malaise, and leukocytosis and include cellulitis, pustular eruptions, furunculosis, wound abscesses, 3 gas gangrene, and extensive ecthyma gangrenosum-like lesions, the latter occurring in patients with underlying malignant neoplasms. A few reports of primary wound infections describe intense local muscle

Abstract: Neonatal osteomyelitis has been frequently reported, but only rarely as a complication of repeated heel punctures. The need for constant monitoring of premature newborns and those having low birthweight and serious deformities necessitates repeated blood samples, usually obtained by heel puncture. Os calcis osteomyelitis occurred in three patients, possibly secondary to heel puncture. A swollen lower extremity in newborns should alert clinicians to the possibility of infection originating in the heel. Treatment involves adequate doses of appropriate antibiotics, but if the infection does not respond within 48 hours, then surgical drainage is indicated. Secondary extension to more proximal areas can and may occur with catastrophic consequences. Orthopedic surgeons should help other physicians become aware that repeated heel punctures may cause os calcis osteomyelitis and that they should be avoided.

Abstract: Making a diagnosis of osteomyelitis or septic arthritis in its early stages if often difficult but is extremely important if one is to reduce the morbidity of these diseases. Nuclear scintigraphy has been proposed as a means of making this early diagnosis with an accuracy rate in the literature that has varied from 85 to 100%. We reviewed 35 patients with osteomyelitis, septic arthritis, and cellulitis who had had nuclear scanning as a part of their initial workup. While we found a 77% accuracy rate, we found three false positives and five false negatives. In order to interpret the scintigraphic results of nuclear imaging accurately, one must be familiar with the mechanisms, both biochemical and physiological, that affect the variable uptake of the nuclear agents employed. Both "hot" and "cold" scans may have multiple causes.

Abstract: In summary, the foot is generally not a common site for the occurrence of squamous cell carcinoma However, since the foot may more frequently be the site of osteomyelitis, one must not ignore the possibility of a squamous cell carcinoma developing as a secondary complication of a chronic draining osteomyelitic sinus In recent years antibiotics have greatly decreased the incidence of chronic osteomyelitis, but have not proved to be the sole answer to bone infections In treating recalcitrant ulcers of unknown etiology that have not responded to conventional modes of therapy, malignancy must be ruled out, especially in light of a foul odor, enlarging mass, increasing pain, and bleeding or radiographic evidence of increased bone destruction Early roentgenographic examination may be the key factor in determining whether the squamous cell carcinoma is, in fact, a primary lesion or rather a secondary complication of chronic osteomyelitis The destruction of bone in squamous cell carcinoma secondary to osteomyelitis is due largely to bacterial infection rather than neoplastic invasion (17) Invading bacteria are thought to break down the natural barriers and allow the neoplasm to enter as a secondary invader; necrotic bone is then replaced by neoplastic bone (4) It is impossible to differentiate grossly or roentgenographically between necrotic bone due to infection and neoplastic bone due to malignancy Therefore it is imperative that these lesions be biopsied to insure accurate diagnosis and adequate therapy and follow-up

Abstract: This is possibly the first documented case of Torulopsis glabrata osteomyelitis. Torulopis glabrata is a common fungus similar to Cryptococcus. It is though to largely represent a contaminant in routine cultures. The patient was a 58-year-old severely debilitated woman with diabetes. To establish a definitive diagnosis, careful culture and positive identification of the causative pathogen from the fresh bone biopsy were required. Treatment with amphotericin B was successful; however, optimally amphotericin B combined with local surgical excision would be the treatment of choice.