title: Primary subacute epiphyseal osteomyelitis: role of conservative treatment.
abstract: Primary subacute epiphyseal osteomyelitis is a rare disease. Owing to its insidious onset, mild symptoms, and inconsistent supportive laboratory data, diagnosis and treatment are usually delayed. The authors report a retrospective review of 16 patients with hematogenous osteomyelitis primarily affecting the epiphysis. In all of these patients an osteolytic lesion developed. In eight patients it was confined to the epiphysis or apophysis alone; in the other patients there was contiguous involvement of the adjacent metaphysis. Complete clinical and radiologic healing was observed in all patients after antibiotic therapy alone. Based on this experience, in view of the controversy in the literature, the authors recommend a conservative treatment policy in the management of both epiphyseal and epiphyseal-metaphyseal subacute osteomyelitis as the treatment of choice. Surgery should be reserved for persistent infection that does not respond to appropriate antibiotic therapy or when bone lesions cannot be distinguished from bone tumors by use of all available imaging modalities.
authors.affiliation: Department of pediatric Orthopedics, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel. pedorth@tasmc.health.gov.il
authors.forename: Eli
authors.initials: E
authors.lastname: Ezra
authors.forename: Nir
authors.initials: N
authors.lastname: Cohen
authors.forename: Eitan
authors.initials: E
authors.lastname: Segev
authors.forename: Shlomo
authors.initials: S
authors.lastname: Hayek
authors.forename: Franklin
authors.initials: F
authors.lastname: Lokiec
authors.forename: David
authors.initials: D
authors.lastname: Keret
authors.forename: Shlomo
authors.initials: S
authors.lastname: Wientroub
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006132:Growth Plate; D006801:Humans; D007223:Infant; D008297:Male; D010019:Osteomyelitis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery; D011859:Radiography; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents