Skip to main content
PMC home page
The Yale Journal of Biology and Medicine logoLink to The Yale Journal of Biology and Medicine
. 1979 Sep-Oct;52(5):423–448.

Pediatric osteomyelitis and septic arthritis: the pathology of neonatal disease.

J A Ogden
PMCID: PMC2595778  PMID: 524924

Abstract

The morphologic and histologic examination of over fifty-five foci of metaphyseal/epiphyseal osteomyelitis and eleven septic joints from five cases of neonatal osteomyelitis and joint sepsis are described in detail. The severity of the bone and joint involvement varied considerably, allowing a better understanding of the pathophysiologic sequence of events in the disease in the neonatal time period. Of particular importance were (1) the multifocal nature of the disease, (2) the highly variable destruction of the growth plate (physis) by several discrete mechanisms, and (3) the invasion of the chondroepiphysis through the cartilage canal systems. Two of the cases died from respiratory complications several months following presumed successful treatment of their skeletal infections. S&pecimens showed significant growth plate damage continuing beyond the neonatal period. These findings support the need for rapid diagnosis and drainage, whenever feasible, to prevent long-term skeletal growth damage. The severity of involvement also should emphasize that this disease, especially in the neonate, is not an innocuous condition, as a recent review suggested.

Full text

PDF

Images in this article

428FIG. 1
on p.428
428FIG. 2
on p.428
429FIG. 3
on p.429
429FIG. 4
on p.429
430FIG. 5
on p.430
430FIG. 6
on p.430
431FIG. 7
on p.431
431FIG. 8
on p.431
432FIG. 9
on p.432
433FIG. 10
on p.433
434FIG. 11
on p.434
435FIG. 12
on p.435
436FIG. 13
on p.436
437FIG. 14
on p.437
437FIG. 15
on p.437
438FIG. 16
on p.438
438FIG. 17
on p.438
439FIG. 18
on p.439
439FIG. 19
on p.439
440FIG. 20
on p.440

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BLANCHE D. W. Osteomyelitis in infants. J Bone Joint Surg Am. 1952 Jan;34-A(1):71–85. [PubMed] [Google Scholar]
  2. Bohrer S. P. Growth disturbances of the distal femur following sickle cell bone infarcts and-or osteomyelitis. Clin Radiol. 1974 Apr;25(2):221–235. doi: 10.1016/s0009-9260(74)80057-7. [DOI] [PubMed] [Google Scholar]
  3. Boxer L. A., Hedley-Whyte E. T., Stossel T. P. Neutrophil action dysfunction and abnormal neutrophil behavior. N Engl J Med. 1974 Nov 21;291(21):1093–1099. doi: 10.1056/NEJM197411212912101. [DOI] [PubMed] [Google Scholar]
  4. Butt W. P. The radiology of infection. Clin Orthop Relat Res. 1973 Oct;(96):20–30. [PubMed] [Google Scholar]
  5. CURTISS P. H., Jr, KLEIN L. Destruction of articular cartilage in septic arthritis. I. In vitro studies. J Bone Joint Surg Am. 1963 Jun;45-A:797–806. [PubMed] [Google Scholar]
  6. Curtiss P. H., Jr, Klein L. Destruction of articular cartilage in septic arthritis. II. In vivo studies. J Bone Joint Surg Am. 1965 Dec;47(8):1595–1604. [PubMed] [Google Scholar]
  7. Curtiss P. H., Jr The pathophysiology of joint infections. Clin Orthop Relat Res. 1973 Oct;(96):129–135. [PubMed] [Google Scholar]
  8. Dich V. Q., Nelson J. D., Haltalin K. C. Osteomyelitis in infants and children. A review of 163 cases. Am J Dis Child. 1975 Nov;129(11):1273–1278. doi: 10.1001/archpedi.1975.02120480007004. [DOI] [PubMed] [Google Scholar]
  9. EYRE-BROOK A. L. Septic arthritis of the hip and osteomyelitis of the upper end of the femur in infants. J Bone Joint Surg Br. 1960 Feb;42-B:11–20. doi: 10.1302/0301-620X.42B1.11. [DOI] [PubMed] [Google Scholar]
  10. Ferguson A. B., Jr Osteomyelitis in children. Clin Orthop Relat Res. 1973 Oct;(96):51–56. [PubMed] [Google Scholar]
  11. Fox L., Sprunt K. Neonatal osteomyelitis. Pediatrics. 1978 Oct;62(4):535–542. [PubMed] [Google Scholar]
  12. Gillespie R. Septic arthritis of childhood. Clin Orthop Relat Res. 1973 Oct;(96):152–159. [PubMed] [Google Scholar]
  13. Gledhill R. B. Subacute osteomyelitis in children. Clin Orthop Relat Res. 1973 Oct;(96):57–69. [PubMed] [Google Scholar]
  14. HALL R. M. Regeneration of the lower femoral epiphysis; report of a case. J Bone Joint Surg Br. 1954 Feb;36-B(1):116–117. doi: 10.1302/0301-620X.36B1.116. [DOI] [PubMed] [Google Scholar]
  15. HUTTER C. G., Jr New concepts of osteomyelitis in the newborn infant. J Pediatr. 1948 May;32(5):522–529. doi: 10.1016/s0022-3476(48)80172-1. [DOI] [PubMed] [Google Scholar]
  16. Halbstein B. M. Bone regeneration in infantile osteomyelitis. Report of a case with fourteen-year follow-up. J Bone Joint Surg Am. 1967 Jan;49(1):149–152. [PubMed] [Google Scholar]
  17. Hutto J. H., Ayoub E. M. Streptococcal osteomyelitis and arthritis in a neonate. Am J Dis Child. 1975 Dec;129(12):1449–1451. doi: 10.1001/archpedi.1975.02120490059018. [DOI] [PubMed] [Google Scholar]
  18. Kahn D. S., Pritzker K. P. The pathophysiology of bone infection. Clin Orthop Relat Res. 1973 Oct;(96):12–19. [PubMed] [Google Scholar]
  19. Kandel S. N., Mankin H. J. Pyogenic abscess of the long bones in children. Clin Orthop Relat Res. 1973 Oct;(96):108–117. [PubMed] [Google Scholar]
  20. Kemp H. B., Lloyd-Roberts G. C. Avascular necrosis of the capital epiphysis following osteomyelitis of the proximal femoral metaphysis. J Bone Joint Surg Br. 1974 Nov;56-B(4):688–697. doi: 10.1302/0301-620X.56B4.688. [DOI] [PubMed] [Google Scholar]
  21. Kuo K. N., Lloyd-Roberts G. C., Orme I. M., Soothill J. F. Immunodeficiency and infantile bone and joint infection. Arch Dis Child. 1975 Jan;50(1):51–56. doi: 10.1136/adc.50.1.51. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. LICHTBLAU P. O., THOMPSON T. C. A femur with two heads and necks; a case report. J Bone Joint Surg Am. 1954 Jun;36-A(3):610–616. [PubMed] [Google Scholar]
  23. Lilien L. D., Harris V. J., Ramamurthy R. S., Pildes R. S. Neonatal osteomyelitis of the calcaneus: complication of heel puncture. J Pediatr. 1976 Mar;88(3):478–480. doi: 10.1016/s0022-3476(76)80272-7. [DOI] [PubMed] [Google Scholar]
  24. Lim M. O., Gresham E. L., Franken E. A., Jr, Leake R. D. Osteomyelitis as a complication of umbilical artery catheterization. Am J Dis Child. 1977 Feb;131(2):142–144. doi: 10.1001/archpedi.1977.02120150024003. [DOI] [PubMed] [Google Scholar]
  25. Miller B. Regeneration of the lateral femoral condyle after osteomyelitis in infancy. A case report with 20-year followup. Clin Orthop Relat Res. 1969 Jul-Aug;65:163–166. [PubMed] [Google Scholar]
  26. OBLETZ B. E. Acute suppurative arthritis of the hip in the neonatal period. J Bone Joint Surg Am. 1960 Jan;42-A:23–30. [PubMed] [Google Scholar]
  27. Ogden J. A. Changing patterns of proximal femoral vascularity. J Bone Joint Surg Am. 1974 Jul;56(5):941–950. [PubMed] [Google Scholar]
  28. Ogden J. A., Light T. R. Pediatric osteomyelitis: II. Arizona hinshawii osteomyelitis. Clin Orthop Relat Res. 1979 Mar-Apr;(139):110–113. [PubMed] [Google Scholar]
  29. Ogden J. A., Lister G. The pathology of neonatal osteomyelitis. Pediatrics. 1975 Apr;55(4):474–478. [PubMed] [Google Scholar]
  30. Overturf G. D., Balfour G. Osteomyelitis and sepsis: severe complications of fetal monitoring. Pediatrics. 1975 Feb;55(2):244–247. [PubMed] [Google Scholar]
  31. Ragnhildstveit E., Ose L. Neonatal osteomyelitis caused by group B streptococci. Scand J Infect Dis. 1976;8(3):219–221. doi: 10.3109/inf.1976.8.issue-3.20. [DOI] [PubMed] [Google Scholar]
  32. Roberts P. H. Disturbed epiphysial growth at the knee after osteomyelitis in infancy. J Bone Joint Surg Br. 1970 Nov;52(4):692–703. [PubMed] [Google Scholar]
  33. SIFFERT R. S. The effect of juxta-epiphyseal pyogenic infection on epiphyseal growth. Clin Orthop. 1957;10:131–139. [PubMed] [Google Scholar]
  34. Silverman F. N. Recovery from epiphyseal invagination: sequel to an unusual complication of scurvy. J Bone Joint Surg Am. 1970 Mar;52(2):384–390. [PubMed] [Google Scholar]
  35. Stetson J. W., DePonte R. J., Southwick W. O. Acute septic arthritis of the hip in children. Clin Orthop Relat Res. 1968 Jan-Feb;56:105–116. [PubMed] [Google Scholar]
  36. Svirsky-Fein S., Langer L., Milbauer B., Khermosh O., Rubinstein E. Neonatal osteomyelitis caused by Candida tropicalis. Report of two cases and review of the literature. J Bone Joint Surg Am. 1979 Apr;61(3):455–459. [PubMed] [Google Scholar]
  37. TRUETA J. The normal vascular anatomy of the human femoral head during growth. J Bone Joint Surg Br. 1957 May;39-B(2):358–394. doi: 10.1302/0301-620X.39B2.358. [DOI] [PubMed] [Google Scholar]
  38. Weissberg E. D., Smith A. L., Smith D. H. Clinical features of neonatal osteomyelitis. Pediatrics. 1974 Apr;53(4):505–510. [PubMed] [Google Scholar]
  39. White A. A., 3rd, Crelin E. S., McIntosh S. Septic arthritis of the hip joint secondary to umbilical artery catheterization associated with transient femoral and sciatic neuropathy. Clin Orthop Relat Res. 1974 May;(100):190–194. [PubMed] [Google Scholar]
  40. Wright W. C., Jr, Ank B. J., Herbert J., Stiehm E. R. Decreased bactericidal activity of leukocytes of stressed newborn infants. Pediatrics. 1975 Oct;56(4):579–584. [PubMed] [Google Scholar]
  41. Zipursky A., Palko J., Milner R., Akenzua G. I. The hematology of bacterial infections in premature infants. Pediatrics. 1976 Jun;57(6):839–853. [PubMed] [Google Scholar]

Articles from The Yale Journal of Biology and Medicine are provided here courtesy of Yale Journal of Biology and Medicine

RESOURCES