Subacute Haematogenous Osteomyelitis of the Calcaneus in a Child: A Case Report and Review of the Literature

摘要

Osteomyelitis is an inflammation of bone caused by a pyogenic organism. Osteomyelitis of the calcaneus in children is an uncommon diagnosis, particularly when haematogenous in nature and not caused by direct inoculation.9 Historically haematogenous osteomyelitis has been characterized as acute, subacute or chronic with each type based on the time of disease onset.7 Subacute haematogenous osteomyelitis is characterized by mild localized bony pain and tenderness usually of more than two weeks duration, mild or no systemic manifestations, noncontributory lab data, negative blood cultures, and positive radiological findings.5 Prior reports and studies have found that children with calcaneal osteomyelitis can be a diagnostic challenge because of the unimpressive signs and symptoms and often marginal lab results. 6 This is made even more difficult when subacute in presentation and associated with a traumatic injury. Therefore we present a case of subacute haematogenous osteomyelitis of the calcaneus with an associated minor traumatic injury, and a review of the literature Introduction Osteomyelitis is an inflammation of bone caused by a pyogenic organism. Osteomyelitis of the calcaneus in children is an uncommon diagnosis, particularly when haematogenous in nature and not caused by direct inoculation.9 Historically haematogenous osteomyelitis has been characterized as acute, subacute or chronic with each type based on the time of disease onset.7 Subacute haematogenous osteomyelitis is characterized by mild localized bony pain and tenderness usually of more than two weeks duration, mild or no systemic manifestations, noncontributory lab data, negative blood cultures, and positive radiological findings.5 Prior reports and studies have found that children with calcaneal osteomyelitis can be a diagnostic challenge because of the unimpressive signs and symptoms and often marginal lab results. 6This is made even more difficult when subacute in presentation and associated with a traumatic injury. Therefore we present a case of subacute haematogenous osteomyelitis of the calcaneus with an associated minor traumatic injury, and a review of the literature. Case Report A 10 year old male presented to the emergency department with a painful right ankle one week after sustaining an injury whilst playing sport. The child had been reluctant to weight bear due to pain and had a decreased range of motion of his ankle. The diagnosis of ankle sprain was made and the child was discharged from the emergency department with crutches and advised to rest and ice the ankle. Four days later the child represented with increasing pain and ongoing inability to weight bear. Radiology showed no evidence of fracture and all observations were normal. However given the childs ongoing symptoms he was put into a cast and referred to the Orthopaedic fracture clinic.