Pathogenesis of acute osteomyelitis in children

(A) During an episode of bacteremia, bacteria are deposited in the metaphysis from the metaphyseal vessels (nutrient artery and vein).
(B) A focus of infection develops in the metaphysis, which leads to cellulitis in the bone marrow.
(C) Exudate under pressure is forced laterally through the Haversian systems and Volkmann canals and into the cortex of the bone, where it can lift or rupture through the periosteum.