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The Journal of Bone and Joint Surgery (American) 83:1810-1813 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Differentiation Between Bone Infarction and Acute Osteomyelitis in Children with Sickle-Cell Disease with Use of Sequential Radionuclide Bone-Marrow and Bone Scans

David L. Skaggs, MD, Sam K. Kim, BS, Nathan W. Greene, MD, Deborah Harris, RN and John H. Miller, MD

Investigation performed at Children’s Hospital Los Angeles, Los Angeles, California

David L. Skaggs, MD
Sam K. Kim, BS
Nathan W. Greene, MD
Deborah Harris, RN
John H. Miller, MD
Departments of Orthopaedic Surgery (D.L.S., S.K.K., N.W.G., and D.H.) and Radiology (J.H.M.), Children’s Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027. E-mail address for D.L. Skaggs: dskaggs{at}chla.usc.edu

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: The differentiation of bone infarction from acute osteomyelitis in patients with sickle-cell disease is challenging, as the clinical presentations of the two conditions are similar and imaging and laboratory studies are of limited value.

Methods: A combination of radionuclide bone-marrow and bone scans was performed sequentially within a twenty-four-hour period (with one exception) to aid in the differentiation between bone infarction and osteomyelitis in seventy-nine consecutive episodes of acute bone pain in children with sickle-cell disease.

Results: Seventy cases of bone infarction were diagnosed on the basis of decreased uptake on the bone-marrow scan and abnormal uptake on the bone scan at the site of pain. Antibiotic administration was discontinued in sixty-six of the seventy cases after the imaging results were obtained, and the bone pain resolved. In four of the seventy-nine cases, there was normal uptake on the bone-marrow scan and abnormal uptake on the bone scan at the site of pain, findings that were suggestive of acute osteomyelitis. In three of these cases, osteomyelitis was proven by culture, and the symptoms in all four resolved with antibiotic treatment. In five of the seventy-nine cases, the bone-marrow and bone scans were normal and thought to indicate neither osteomyelitis nor bone infarction; in all of these cases, the symptoms resolved without the use of antibiotics.

Conclusions: These findings suggest that osteomyelitis can be differentiated from bone infarction in children with sickle-cell anemia and acute bone pain by a combination of sequential bone-marrow and bone scintigraphy.


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