CHRONIC RECURRENT OSTEOMYELITIS WITH CLAVICULAR INVOLVEMENT IN CHILDREN - DIAGNOSTIC-VALUE OF DIFFERENT IMAGING TECHNIQUES AND THERAPY WITHNONSTEROIDAL ANTIINFLAMMATORY DRUGS

Chronic recurrent, uni- or multifocal osteomyelitis (CRMO), an inflamm atory disorder of unknown origin, involves mk:/night/arul/4310946m.3du ltiple osseous sites and may affect the clavicle. We report on 6 child ren with clavicular involvement out of 11 children suffering from CRMO . The major clinical symptoms were local swelling and pain. Five child ren had hyperostosis of the clavicle and synovitis of adjacent joints. Histology showed chronic osteomyelitis with a predominance of lymphoc ytes in the inflammatory infiltrates. Cultures of biopsy tissue specim ens were sterile. The patients were followed for at least 3.5 years. T hree patients had up to six relapses. The most effective diagnostic to ols to define CRMO were standard X-ray and bone scan in combination wi th biopsy and cultures. In our patients CT and MRI were misleading as they suggested the presence of malignancy. However, the sensitivity of MRI to detect involvement of bone, adjacent joints and soft tissues w ere better in comparison to X-ray or bone scan. Non-steroidal anti-inf lammatory drugs were effective in reducing pain, swelling and limitati on of motion. Reconstructive surgery was not indicated in any case. Th e long-term outcome of growth and function of affected bones was excel lent. Conclusion Diagnosis of chronic osteomyelitis of the clavicle sh ould be made by history and physical examination and be confirmed by s tandard X-ray, bone scan and open biopsy. In contrast MRI and CT can p rovide data on the involvement of adjacent joints, soft tissue and mus cles especially in the early process of disease, but do not add inform ation relevant to the patient's management. Treatment with non-steroid al anti-inflammatory drugs is rapidly beneficial in most patients.