As the abscess enlarges>> intramedullary pressure increases >>> cortical ischemia, which may allow purulent material to escape through the cortex into the subperiosteal space. >>subperiosteal abscess then develops
Small capillaries cross the epiphyseal growth plate and permit extension of infection into the epiphysis and joint space
The cortical bone of neonates and infants is thin and loose, consisting predominantly of woven bone, which permits escape of the pressure caused by infection but promotes rapid spread of the infection directly into the subperiosteal region.
In patients with sickle cell anemia and osteomyelitis, the primary bacterial causes are S aureus and Salmonellae species the primary choice for treatment is a fluoroquinolone antibiotic (not in children).
A third-generation cephalosporin (eg, ceftriaxone) is an alternative choice