d cultures are positive for half of children with acute osteomyelitis. If pockets of pus are present over infections sites, samples can be collected for culture to identify the bacteria present (Carson-DeWitt, 2001). A bone biopsy can be taken and tested for bacteria present, and is the gold standard for diagnosing osteomyelitis, although this technique is hampered by the lack of uniformity of specimen collection (Carek, Dickerson and Sack, 2001; Carson-DeWitt, 2001). In diabetic patients, palpation in the depths of infected pedal ulcers strongly correlates with underlaying osteomyelitis (Carek, Dickerson and Sack, 2001).
Plain film radiography and bone scintigraphy are the primary diagnostic tools used in osteomyelitis (Carek, Dickerson and Sack, 2001). Radiographic evidence of bone destruction appears usually after about two weeks, and the radiographs may reveal osteolysis, periosteal reaction, and segments of necrotic bone separated from living bone by granular tissue. Bone abscesses may be present. Nuclear
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