Figs 38.44 to C: (A) Spread of pus from the metaphysis in children of less than 2 years. Subperiosteal common, joint involvement rare but still joint can be involved in two ways: (1) If the capsule encloses the metaphyseal region, (2) Through the common blood supply from the nutrient vessel which gives rise to metaphyseal and epiphyseal vessels; (B) Spread in children between 2 and 16 years. In this age group, diaphyseal spread is common; (C) Spread in patients >16 years. In this age, joint involvement may be direct because the growth plate has disappeared (J—joint, E—epiphysis, M—metaphysis, D—diaphysis, and X—no spread) eo a tr Figs 38.3 to C: Pathological events in acute osteomyelitis in <2 years: (A) Beginning of the infection in the metaphysis; (B) Formation of a subperiosteal abscess; (C) Formation of a discharging sinus and sequestrum Cavity Sequestrum Sinus ‘Subperiosteal abscessD —E G Fig. 38.5: Entire spectrum of pathological changes in osteomyelitis: (A) Sequestrum, (B) Periosteum, (C) Pus, (D) Cortex, (E) Involucrum, (F) Bone abscess, and (G) Medullary cavity