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Casting of the ankle and observation
5%
107/2114
CT of the tibia
2%
52/2114
Oral antibiotic therapy, with outpatient follow-up in 6 weeks
Biopsy and culture of the tibial lesion
86%
1822/2114
Urgent ankle arthrotomy
3%
66/2114
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The patient's presentation is consistent with subacute osteomyelitis, with the development of a Brodie's abscess as shown in Figures B-D. McCarthy et al in their ICL on pediatric musculoskeletal infections state that initially, the most important aspect of treating children and adolescents with subacute hematogenous osteomyelitis is ruling out tumors. Therefore, in addition to cultures of involved tissue, a biopsy is needed. They also state that if infection is confirmed, treatment consists of administration of appropriate antibiotics and, when the osteomyelitis is chronic (with symptoms for more than one month), débridement and removal of any sequestrum may be required. Patients with this condition usually do not have any constitutional symptoms, and lab work-up may be normal.
3.9
(37)
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