Bone Pathology Database

Teaching Version


Text in Italics is general (instructional) information

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2nd image
X ray
Third image
X ray some months after
4th image
X ray at 6 months

The hip was tender to movement and the boy was admitted to the intensive care, resuscitated and then the hip was opened. At arthrotomy purulent fluid was noted in the hip. The femoral shaft was also drained. (These drill holes can be seen on the x ray on the previous page.) He was placed on intravenous antibiotics. A staphylococcus aureus was subsequently cultured from both blood culture, and from the pus swabs taken intraoperatively.

The top xray shows the early response of the femur to the chronic sepsis ar about three weeks. There is a periosteal reaction and the femur has become osteopaenic.

The middle X ray shows the femur about six months late there is new bone formation (involucrum) and the shaft has thickened.

The lower X ray shows the hip at about 6 months. It can be seen that the hip space has widened because of chronic synovitis, the femoral head has separated and is necrotic. Part of the femur neck has formed s sequestrum.

This child was referred late and despite prompt drainage the sepsis became chronic. The sepsis probably originated in the femur and then spread to the hip joint ( the capsule of the hip communicates with the metaphysis and acute osteomyelitis can spread into the hip and vice versa). The series of xrays illustrates the progression from acute ostomyelitis where little is seen on x rays. To periosteal reaction (first X ray changes usually only begin at 14 days+). Later the periosteal membrane forms new bone and areas od dead bone are isolated as sequestrae.

This case illustrates many of these late complications. Growth disturbance will certainly follow as the proximal growth plate has been destroyed!


Record 99