Pediatric Osteomyelitis Clinical Presentation

Updated: Feb 11, 2022
  • Author: Sabah Kalyoussef, DO; Chief Editor: Russell W Steele, MD  more...
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Long bones, including the femur, tibia, and humerus, are most commonly affected.

Fever, localized pain, swelling, redness, and guarding the affected body part are common.

Inability to support weight and asymmetric movement of extremities are often early signs in newborns and young infants.


Physical Examination

Often, patients are able to localize the infected bone on examination, owing to pain.

Symptoms include focal swelling with cardinal signs of inflammation with or without fever and focal point tenderness over the affected bone. It is important to note whether the adjacent joint is involved by assessing the range of motion of the joint and signs of inflammation. Arthritis found on examination may be a reactive inflammatory response or a sign of an infected joint.

Draining sinus and bone deformity are both rare in acute disease. When present, these symptoms suggest subacute or chronic osteomyelitis.

Cellulitis, subcutaneous abscess, fractures, and bone tumors should be considered in the differential diagnosis.

In newborns and infants in whom osteomyelitis may present as a pseudoparalysis, also consider CNS disease (eg, poliomyelitis), cerebral hemorrhage, trauma, scurvy, and child abuse.