Investigations

If the patient is experiencing an acute flare-up of the condition, there may be an elevated white cell count with moderately elevated acute phase reaction such as ESR and CRP. Blood cultures are generally negative. Swabs taken from any discharging sinuses will often just grow skin flora and there is extreme difficulty in isolating an organism in these individuals as they have often had multiple courses of antibiotics.

Plain radiographs may show a complete alteration of the architecture of a long bone with an abnormal shape, marked new bone formation surrounding a cavity that contains sclerotic bone or sequestra or an involucrum extending along the length of the diaphysis, depending on the extent of the disease. There may be destruction of associated growth plates with resultant shortening of the bone. If there has been antigen spread into an adjacent joint with resultant septic arthritis, there may be complete destruction or degenerative changes within the adjacent joints.

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