{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:53:23Z","timestamp":1790790803256,"version":"4.1.0"},"reference-count":31,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,3,30]],"date-time":"2023-03-30T00:00:00Z","timestamp":1680134400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Transphyseal hematogenous osteomyelitis (THO) is a serious condition that can affect the growing physis, yet it is insufficiently recognized in children. The aim of this study was to explore the prevalence and epidemiology of pediatric THO, and to discuss the underlying pathophysiology. All consecutive cases of acute and subacute osteomyelitis admitted to our institution over 17 years were retrospectively studied. Medical records were examined for patient characteristics, bacteriological etiology, and medical and surgical management. Magnetic resonance imaging was reviewed for all patients to identify those with transphyseal spread of infection. For positive cases, the surface area of the transphyseal lesion was estimated relative to the total physeal cross-sectional area. Fifty-four (25.7%) of the 210 patients admitted for acute or subacute osteomyelitis were diagnosed with THO. The study population\u2019s ages ranged from 1 month to 14 years old (median age 5.8 years, interquartile range 1\u2013167 months). Fourteen (25.9%) patients were younger than 18 months old; the remaining 40 (74.1%) had a mean age of 8.5 years old. The most common sites of THO were the distal tibia (29.1%), the proximal tibia (16.4%), and the distal fibula (14.5%).\u00a0Transphyseal lesions were due to acute infection in 41 cases and to subacute osteomyelitis in 14 cases. The two most frequently identified pathogens were Staphylococcus aureus (49.1%) and Kingella kingae (20.0%). An average transphyseal lesion represented 8.9% of the total physeal surface, and lesions comprised more than 7% of the physeal cross-sectional area in 51% of cases. Our study revealed that pediatric THO was more frequent than commonly thought. Transphyseal lesions were frequently above this 7% cut-off, which is of paramount importance since subsequent growth is more likely to be disturbed when more than 7% of the physeal cross-sectional area is injured. THO also affected children older than 18 months, an age at which transphyseal arterial blood supply to the epiphysis is believed to have disconnected. This finding suggests another pathophysiological reason for the transphyseal diffusion of infection, a topic deserving further studies and greater understanding.<\/jats:p>","DOI":"10.3390\/microorganisms11040894","type":"journal-article","created":{"date-parts":[[2023,3,30]],"date-time":"2023-03-30T03:17:35Z","timestamp":1680146255000},"page":"894","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Transphyseal Hematogenous Osteomyelitis: An Epidemiological, Bacteriological, and Radiological Retrospective Cohort Analysis"],"prefix":"10.3390","volume":"11","author":[{"given":"Blaise","family":"Cochard","sequence":"first","affiliation":[{"name":"Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, CH-1211 Geneva, Switzerland"},{"name":"Division of Orthopedics and Trauma Surgery, Geneva University Hospitals, CH-1211 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9line","family":"Habre","sequence":"additional","affiliation":[{"name":"Pediatric Radiology Unit, Geneva Children\u2019s Hospital, Geneva University Hospitals, CH-1211 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nastassia","family":"Pralong-Guanziroli","sequence":"additional","affiliation":[{"name":"Division of Orthopedics and Trauma Surgery, Geneva University Hospitals, CH-1211 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9811-8247","authenticated-orcid":false,"given":"Nathaly","family":"Gavira","sequence":"additional","affiliation":[{"name":"Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, CH-1211 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Di Laura Frattura","sequence":"additional","affiliation":[{"name":"Division of Orthopedics and Trauma Surgery, Geneva University Hospitals, CH-1211 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Di Marco","sequence":"additional","affiliation":[{"name":"Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, CH-1211 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina N.","family":"Steiger","sequence":"additional","affiliation":[{"name":"Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, CH-1211 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geraldo","family":"De Coulon","sequence":"additional","affiliation":[{"name":"Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, CH-1211 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romain","family":"Dayer","sequence":"additional","affiliation":[{"name":"Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, CH-1211 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4038-4881","authenticated-orcid":false,"given":"Dimitri","family":"Ceroni","sequence":"additional","affiliation":[{"name":"Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, CH-1211 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1570","DOI":"10.2106\/JBJS.M.00791","article-title":"Primary Epiphyseal or Apophyseal Subacute Osteomyelitis in the Pediatric Population: A Report of Fourteen Cases and a Systematic Review of the Literature","volume":"96","author":"Ceroni","year":"2014","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1302\/0301-620X.51B3.458","article-title":"Subacute Haematogenous Osteomyelitis","volume":"51","author":"King","year":"1969","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1097\/01241398-200205000-00012","article-title":"Primary Subacute Epiphyseal Osteomyelitis: Role of Conservative Treatment","volume":"22","author":"Ezra","year":"2002","journal-title":"J. Pediatr. Orthop."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.3928\/0147-7447-19861101-13","article-title":"Subacute Pyogenic Osteomyelitis","volume":"9","author":"Gillespie","year":"1986","journal-title":"Orthopedics"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Gledhill, R.B. (1973). Subacute Osteomyelitis in Children. Clin. Orthop., 57\u201369.","DOI":"10.1097\/00003086-197310000-00010"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1097\/01241398-199603000-00017","article-title":"Subacute Hematogenous Osteomyelitis: Are Biopsy and Surgery Always Indicated?","volume":"16","author":"Hamdy","year":"1996","journal-title":"J. Pediatr. Orthop."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1302\/0301-620X.47B3.526","article-title":"Primary Subacute Pyogenic Osteomyelitis","volume":"47","author":"Harris","year":"1965","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1302\/0301-620X.69B5.3680342","article-title":"Osteomyelitis in a General Hospital. A Five-Year Study Showing an Increase in Subacute Osteomyelitis","volume":"69","author":"Jones","year":"1987","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1007\/BF01644340","article-title":"Brodie\u2019s Abscess in the First Decade of Life. Report of Eleven Cases","volume":"10","author":"Kozlowski","year":"1980","journal-title":"Pediatr. Radiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1097\/01241398-198208000-00003","article-title":"Subacute Hematogenous Osteomyelitis in Children: A Retrospective Study","volume":"2","author":"Roberts","year":"1982","journal-title":"J. Pediatr. Orthop."},{"key":"ref_11","first-page":"76","article-title":"Multifocal Subacute Pyogenic Osteomyelitis in a Child. A Case Report","volume":"116","author":"Season","year":"1976","journal-title":"Clin. Orthop."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1302\/0301-620X.79B6.0790983","article-title":"Primary Subacute Haematogenous Osteomyelitis of the Tarsal Bones in Children","volume":"79","author":"Ezra","year":"1997","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1302\/0301-620X.103B3.BJJ-2020-0936.R2","article-title":"Osteoarticular Infection in Children","volume":"103-B","author":"Coulin","year":"2021","journal-title":"Bone Jt. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1097\/01.inf.0000259954.88139.f4","article-title":"Specific Real-Time Polymerase Chain Reaction Places Kingella Kingae as the Most Common Cause of Osteoarticular Infections in Young Children","volume":"26","author":"Chometon","year":"2007","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1302\/0301-620X.39B2.358","article-title":"The Normal Vascular Anatomy of the Human Femoral Head during Growth","volume":"39-B","author":"Trueta","year":"1957","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_16","first-page":"306","article-title":"The 3 types of acute hematogenous osteomyelitis","volume":"93","author":"Trueta","year":"1963","journal-title":"Schweiz. Med. Wochenschr."},{"key":"ref_17","first-page":"423","article-title":"Pediatric Osteomyelitis and Septic Arthritis: The Pathology of Neonatal Disease","volume":"52","author":"Ogden","year":"1979","journal-title":"Yale J. Biol. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1302\/0301-620X.68B2.3958014","article-title":"Acute Haematogenous Osteomyelitis and Septic Arthritis\u2013A Single Disease. An Hypothesis Based upon the Presence of Transphyseal Blood Vessels","volume":"68","author":"Alderson","year":"1986","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"190","DOI":"10.2214\/AJR.13.11279","article-title":"Transphyseal Involvement of Pyogenic Osteomyelitis Is Considerably More Common than Classically Taught","volume":"203","author":"Wright","year":"2014","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Long, S.S., Pickering, L.K., and Prober, C.G. (2003). Principles and Practice of Pediatric Infectious Diseases, Churchill Linvingstone. [2nd ed.].","DOI":"10.1097\/00024382-200307000-00020"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1016\/S0030-5898(20)30956-1","article-title":"Hematogenous Pyogenic Osteomyelitis in Children","volume":"6","author":"Morrey","year":"1975","journal-title":"Orthop. Clin. N. Am."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Cherkaoui, A., Emonet, S., Ceroni, D., Candolfi, B., Hibbs, J., Francois, P., and Schrenzel, J. (2009). Development and Validation of a Modified Broad-Range 16S RDNA PCR for Diagnostic Purposes in Clinical Microbiology. J. Microbiol. Methods, 79.","DOI":"10.1016\/j.mimet.2009.09.014"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1099\/jmm.0.47707-0","article-title":"Molecular Diagnosis of Kingella Kingae Osteoarticular Infections by Specific Real-Time PCR Assay","volume":"58","author":"Cherkaoui","year":"2009","journal-title":"J. Med. Microbiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e230","DOI":"10.1542\/peds.2012-0810","article-title":"Detection of Kingella Kingae Osteoarticular Infections in Children by Oropharyngeal Swab PCR","volume":"131","author":"Ceroni","year":"2013","journal-title":"Pediatrics"},{"key":"ref_25","first-page":"DC07","article-title":"Accessory Gene Regulator Types of Staphylococcus Aureus Isolated in Gorgan, North of Iran","volume":"8","author":"Bibalan","year":"2014","journal-title":"J. Clin. Diagn. Res. JCDR"},{"key":"ref_26","first-page":"487","article-title":"Frequency Of Panton Valentine Leucocidin Gene In Staphylococcus Aureus From Skin And Soft Tissue Infections","volume":"32","author":"Akram","year":"2020","journal-title":"J. Ayub Med. Coll. Abbottabad JAMC"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Merlini, L., Anooshiravani, M., and Ceroni, D. (2015). Concomitant Septic Arthritis and Osteomyelitis of the Hip in Young Children; a New Pathophysiological Hypothesis Suggested by MRI Enhancement Pattern. BMC Med. Imaging, 15.","DOI":"10.1186\/s12880-015-0057-0"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"961","DOI":"10.2106\/00004623-197658070-00011","article-title":"The Arterial Supply of the Developing Proximal End of the Human Femur","volume":"58","author":"Chung","year":"1976","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1097\/01241398-200001000-00009","article-title":"The Incidence of Joint Involvement with Adjacent Osteomyelitis in Pediatric Patients","volume":"20","author":"Perlman","year":"2000","journal-title":"J. Pediatr. Orthop."},{"key":"ref_30","first-page":"187","article-title":"The Effect of Trauma to the Lower Femoral Epiphyseal Plate. An Experimental Study in Rabbits","volume":"70","author":"Vihtonen","year":"1988","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1148\/radiology.191.2.8153295","article-title":"Imaging of Epiphyseal Injuries","volume":"191","author":"Rogers","year":"1994","journal-title":"Radiology"}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/11\/4\/894\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:06:50Z","timestamp":1760123210000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/11\/4\/894"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,30]]},"references-count":31,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,4]]}},"alternative-id":["microorganisms11040894"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms11040894","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,30]]}}}