In acute hematogenous osteomyelitis of childhood, the earliest microscopic changes in bone are in the
|C||Subperiosteal portion of the metaphysis|
|D||Subperiosteal portion of the diaphysis|
a. Hematogenous osteomyelitis of childhood begins as a focus of infection in the metaphysis adjacent to the epiphyseal plate; it is there that the earliest microscopic changes would be found.
b. Only later does the infection extend to the diaphysis or subperiosteal area, and the infection involves the epiphysis only if concurrent septic arthritis is present.