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Paediatrics
Published in David A Lisle, Imaging for Students, 2012
Osteomyelitis refers to infectious inflammation of bone. Osteomyelitis may occur at any age, though is more common in young children with over 50 per cent of cases occurring before the age of five. Common sites of involvement are the metaphyses of long bones, growth centres (metaphyseal equivalents) in the pelvis, mandible and spine. Osteomyelitis is usually due to haematogenous spread from respiratory or urinary tract infection. Less commonly, osteomyelitis may be due to direct penetration, especially of the calcaneus or distal toes. The most common organisms causing childhood osteomyelitis are Staphylococcus aureus, β-haemolytic streptococcus and Streptococcus pneumoniae. (In adults, osteomyelitis may occur from a number of causes including compound fractures, adjacent soft tissue infection, diabetes and intravenous drug use.) Clinical presentation of osteomyelitis in children is variable, although usually consists of pain, local tenderness and fever. In younger children, symptoms may be less specific, e.g. development of a limp, unwillingness to use affected limb, lethargy and poor feeding in neonates.
The cases
Published in Chris Schelvan, Annabel Copeman, Jacky Davis, Annmarie Jeanes, Jane Young, Paediatric Radiology for MRCPCH and FRCR, 2020
Chris Schelvan, Annabel Copeman, Jacky Davis, Annmarie Jeanes, Jane Young
Osteomyelitis usually presents with sudden onset of local bone pain, swelling, erythema, and immobility. Long bones are most commonly affected. The child is systemically unwell with fever and malaise. Blood cultures are positive in 60%.
Biomedical applications of polymer and ceramic coatings: a review of recent developments
Published in Transactions of the IMF, 2022
J. R. Smith, D. A. Lamprou, C. Larson, S. J. Upson
Bacterial infection resulting from orthopaedic implants (osteomyelitis) is a leading cause of implant failure and revision surgery.5 Chitosan (CS, a natural polysaccharide derived from crustaceans) combined with Aloe vera (CS/AV) loaded with gentamicin sulphate (GS) has been electrodeposited under potentiostatic conditions (–2.5 V vs. SCE, 3-electrode system for 45 min) onto a Ti alloy. Increased antibacterial activity against Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) was found.5 Chitosan-bioactive glass (CS-BG) nanocomposite coatings have been applied to Ti6Al4V using cathodic electrophoretic deposition by Mahlooji et al.6 Increased BG content enhanced the apatite-forming ability of the coating, adhesion strength, roughness and wettability; good cell attachment and no significant levels of cytotoxicity were reported following this procedure. Mohan Raj et al. anodised Ti (at 50 V DC for 120 min in an electrolyte containing 3% sodium fluorosilicate), producing a TiO2-SiO2 surface onto which was subsequently electrodeposited (−2.5 V vs. SCE for 45 min) a CS-lysine biopolymer coating and a final electrodeposited (−2.5 V vs. SCE for 45 min) coating GS (50 mg mL−1 GS in the electrolyte), as a model drug.7 The coating offered improved corrosion resistance and antimicrobial activity (S. aureus and E. coli) in addition to good osteoblast adhesion and growth. Kumari et al. carried out a systematic review on the use of CS-modified metallic and polymer scaffolds that are reported to enhance the biocompatibility, corrosion resistance and antibacterial properties of metallic implants.8 Coating methods for CS using electrophoretic deposition, sol–gel methods, dip coating, spin coating or electrospinning are discussed.