Separation of an epiphysis nearly always results in infection and
destruction of the adjacent joint.
Osteomyelitis is rare in the bones of the carpus and tarsus, and the
associated joints are usually infected from the outset. In flat bones,
such as the skull, the scapula, or the ilium, suppuration usually occurs
on both aspects of the bone as well as in the marrow.
_Clinical Features._--The constitutional symptoms, which are due to the
associated toxaemia, vary considerably in different cases. In mild cases
they may be so slight as to escape recognition. In exceptionally severe
cases the patient may succumb before there are obvious signs of the
localisation of the staphylococci in the bone marrow. In average cases
the temperature rises rapidly with a rigor and runs an irregular course
with morning remissions, there is marked general illness accompanied by
headache, vomiting, and sometimes delirium.
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