Orthopedics · Bone and Joint Infections (Osteomyelitis, Septic Arthritis)

In acute hematogenous osteomyelitis in children, after how many days do characteristic radiographic changes (periosteal reaction and lytic lesions) typically become visible on plain X-ray?

  • A 1-2 days
  • B 3-5 days
  • C 7-14 days
  • D 21-28 days
Correct answer: C. 7-14 days

Explanation

Plain radiographic changes in acute osteomyelitis, including periosteal reaction and lytic lesions, become visible only after 7-14 days. Early in the disease (first week), X-ray is typically normal despite active infection. MRI can detect changes within 24-48 hours. This is a frequently tested fact distinguishing imaging modalities in early versus established osteomyelitis.

Reference: Tachdjian's Pediatric Orthopaedics, 5th ed.

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