Acute haematogenous osteomyelitis of femur in a neonate with ‘bone within bone’ appearance: a case report

Nadeem Ali, Abedullah Bhat, Firdous A. Bangroo, Suhail Ahmad Bhat


Acute osteomyelitis in infants, which was known for high mortality and morbidity in the pre-antibiotic era can be managed conservatively by intravenous antibiotics and supportive therapy if the condition is detected and treatment started early in the course of the disease. Infantile osteomyelitis is separate entity from the one seen in older children in terms of vascular anatomy, pathogenesis, radiological changes and natural history. We present a neonate with acute haematogenous osteomyelitis of femur with preceding respiratory tract infection that was managed conservatively without surgical intervention despite severe radiographic changes. The child recovered without any residual deformity and final radiographs did not show any trace of the disease though early radiographs had exuberant involucrum formation and sequestration of entire diaphysis giving it a “bone within bone” appearance. Infants have excellent capacity of re-sorption of sequestrum and remodelling of involucrum such that no trace of disease is left in the adulthood.


Acute haematogenous osteomyelitis, Sequestrum, Involucrum, Bone within bone, Periosteal reaction

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Nade S. Acute haematogenous osteomyelitis in infancy and childhood. J Bone Joint Surg Br 1983;65(2):109-19.

Mader J, Mohan D, Calhoun J. A practical guide to the diagnosis and management of bone and joint infections. Drugs 1997;54(2):253-64.

Ikpeme IA, Ngim NE, Ikpeme AA. Diagnosis and treatment of pyogenic bone infections. Afr Health Sci 2010;10(1):82-8.

Mitchell A. Treatment of acute osteomyelitis by uleron. Br Med J 1938:ii:1200.

Trueta J. The three types of acute haematogenous osteomyelitis: a clinical and vascular study. J Bone Joint Surg Br 1959:41-B:671-80.

Thomson J, Lewis IC. Osteomyelitis in the newborn. Arch Dis Child 1950;25(123):273-9.

Trueta J. The Normal Vascular Anatomy of the Human Femoral Head during Growth. J Bone Joint Surg Br 1957;39-B:358.

Trueta J. La vascularisation des as et l’osteogenese. Revue de Chirurgie Orthopedique 1958;44:3.

Stephen RF, Benson MKD, Nade S. Misconceptions about childhood acute osteomyelitis. J Child Orthop 2012;6:353-56.