Posterior Subperiosteal Abscess of the Distal Femur in a Pediatric Patient: A Rare Surgical Presentation of Acute Hematogenous Osteomyelitis

Authors

• Michael Dearman, University of Texas at TylerFollow
• Corey Bindner, University of Texas Health Center at Tyler

Document Type

Poster

Publication Date

2026

Abstract

Introduction: Pediatric osteomyelitis commonly arises from acute hematogenous spread and remains diagnostically challenging due to limited radiographic findings and difficulty obtaining MRI in young children. Subperiosteal abscess formation is an uncommon but serious complication, with posterior distal femoral involvement reported only once previously.

Case Report: A 19-month-old male presented with fever and refusal to bear weight. Initial radiographs were unremarkable. Worsening symptoms prompted admission with rising inflammatory markers and blood cultures positive for gram positive cocci. MRI demonstrated distal femoral metaphyseal osteomyelitis with a posterior subperiosteal abscess. Through an anterior arthrotomy and metaphyseal drilling, osteomyelitis and joint involvement were addressed. Blunt medial dissection allowed access to the posterior femoral abscess. Cultures grew MSSA. The patient completed IV and oral antibiotics with full recovery.

Discussion: Subperiosteal abscess formation occurs in only 4 to 5 percent of pediatric osteomyelitis cases, and posterior distal femoral involvement is exceedingly rare. MRI was essential in identifying both metaphyseal osteomyelitis and the posterior abscess, enabling operative planning. An anterior to posterior approach allowed complete debridement while minimizing risk to the popliteal neurovascular structures and represents a previously undescribed surgical strategy. Clinical risk tools such as the Kocher criteria and the novel Alexander criteria support early recognition and appropriate use of imaging.

Conclusion: Posterior distal femoral subperiosteal abscess is a rare complication of pediatric osteomyelitis that can be safely managed through an anterior to posterior surgical approach. Early application of novel clinical risk criteria may assist in identifying children who warrant advanced imaging and timely operative intervention.

Journal/Conference Details

Presented at the 2026 UT Tyler School of Medicine Research Day.

Persistent Identifier

http://hdl.handle.net/10950/5159

Recommended Citation

Dearman, Michael and Bindner, Corey, "Posterior Subperiosteal Abscess of the Distal Femur in a Pediatric Patient: A Rare Surgical Presentation of Acute Hematogenous Osteomyelitis" (2026). School of Medicine Student Publications and Presentations. Paper 6.