1. Subacute hematogenous
osteomyelitis
Dr muthoka

2. • Common as acute
• Less virulent organisms/ pt is more
resistant(both)
• More variable in skeletal distribution
• Distal femur, proximal and distal tibia are
favourite sites

3. PATHOLOGY
• Typically there is a well defined cavity in
cancellous bone (tibia metaphysis) containing
glairy seropurulent fluid(rarely pus)
• The cavity is lined by granulation tx containing
a mixture of acute and chronic inflammatory
cells

4. CLINICAL FEATURES
• Usually a child or adolescent
• Pain near one of the large joints for several
weeks or even months
• Limp
• Slight swelling, muscle wasting & local
tenderness.
• Temp is normal
• Wbc and blood culture are normal
• Esr- elevated

5. imaging
• Xray- circumscribed round or oval radiolucent
cavity 1-2cm in diameter
• Most often in tibia & femoral metaphysis
• Brodie’s abscess- the cavity is surrounded by a
halo of schlerosis.
• Metaphyseal lesion cause little or no
periosteal reaction
• Diphysis- marked new bone formation
&cortical thickening

6. diagnosis
• Clinical & xray appearance resemble those of
cystic tb, eosinophilic granuloma,or osteoid
osteoma.
• Mimick bone tumors eg ewings sarcoma

7. treatment
• Conservative rx
• Immobilization and antibiotics; flucloxacillin
and fusidic acid iv for 4 or5 days then orally for
6 weeks
• Open biopsy is needed and the lesion curreted
• Curretage is donr if there is no healing after
conservative rx.
• Then ct antibiotics