A 6-year-old child presents with pain and swelling of the right knee for 3 months. Radiograph shows epiphyseal involvement with a lytic lesion in the distal femoral epiphysis. Which statement about skeletal tuberculosis in children is correct?

• A Epiphyseal involvement is rare in children because the growth plate acts as a barrier
• B Children with skeletal TB never develop epiphyseal involvement
• C Skeletal TB in children primarily involves the metaphysis, similar to acute osteomyelitis
• D Epiphyseal involvement is more common in children than adults due to transphyseal vessels ✓

Explanation

In children, epiphyseal involvement in tuberculosis is more common than in adults because transphyseal vessels allow spread from the metaphysis to the epiphysis. The growth plate does not act as an effective barrier in TB. In adults, the epiphysis is supplied separately and involvement occurs via synovial spread. Acute pyogenic osteomyelitis primarily involves the metaphysis.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

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