ACUTE hematogenous osteomyelitis in the long bones of adults is a rare disease. In 1938 Zadek1 described the condition and reported nine cases which illustrated typical findings. He emphasized that hematogenous osteomyelitis in adults has a slow and insidious onset. The temperature and white blood cell count (WBC) are often only slightly elevated. The process begins in the diaphysis rather than metaphysis. There may be spread along the whole length of bone and extension into the joints. X rays reveal spotty atrophy of the cortex over an area of several inches. There is local erosion of bone, no sequestrum formation occurs, and new bone formation has a laminated appearance. Trueta2 in 1959 divided acute hematogenous osteomyelitis into three types: infant, childhood, and adult. The findings in each type were distinct and the diverse clinical picture of each age group was logically explained. In adults, he described findings similar
Smith AG. Hematogenous Friedländer's Bacillus Osteomyelitis. JAMA. 1966;195(12):1060–1061. doi:10.1001/jama.1966.03100120128042
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