In pediatric hematogenous osteomyelitis, which bone is most commonly involved?

• A. Feet
• B. Long Bones
• C. Hands
• D. Pelvis

Answer: (B)

In pediatric hematogenous osteomyelitis, the infection most often involves the metaphysis of long bones. This happens because the metaphyseal region has a rich network of slow-flow red marrow and many capillaries, which makes it a prime destination for bacteria traveling through the bloodstream to lodge and establish infection. In younger children, vessels can cross the growth plate, but the disease typically stays in the metaphysis, producing focal bone pain, swelling, and fever. The distal femur, proximal tibia, and proximal humerus are common sites because of their prominent metaphyseal blood supply. Other sites like the feet, hands, or pelvis can be involved, but they’re less frequently affected compared with the long-bone metaphyses.