ULTRASONOGRAPHY IN ACUTE OSTEOMYELITIS OF LONG BONES IN CHILDREN - DIAGNOSTIC AND PROGNOSTIC VALUE

Between 1991 and 1994, ultrasonography was used to investigate 90 cons ecutive children with acute osteomyelitis. Ultrasonographic findings w ere analyzed taking into account the time elapsed from first symptoms. Outcome in 47 children who were treated and followed for at least 6 m onths was also studied. Deep soft tissue swelling adjacent to the affe cted bone was found to be an early but nonspecific sign which persiste d all along the course of the disease. Periosteal elevation smaller th an 3 mm, secondary to exsudation or septic fluid, confirmed the diseas e in earliest stage and was the most frequent ultrasonographic sign in first three days of disease. Treated at that stage, total resolution was obtained in 66% of patients and stabilization, in 34% of cases, wi thout any evolution toward chronicity. Acute osteomyelitis with subper iosteal abscess progressed toward stabilization in 66% of cases and to ward chronic osteomyelitis in 8% of cases. 32% of subperiosteal absces s were ruptured; in such situation, progression to chronicity was obse rved in 26% of patients. Since ultrasonography has been used in our in stitution for the diagnosis of acute osteomyelitis, the rate of evolut ion to chronicity spectacularly dropped from 63% to 11%. The main adva ntage of ultrasonography is an earlier detection of subperiosteal coll ection that indicates surgical drainage without any delay.