Intracortical fissuring in osteomyelitis.

Cortical fissuring, a well-recognized radiographic sign of osteomyelitis, represents spread of infection through the haversian system with osteoclastic bone resorption. In the proper clinical setting this finding may be recognized before there is other evidence of bone destruction or periosteal reaction. Three cases are presented that illustrate the sign at a relatively early stage in the progress of the osteomyelitis. While fissuring was previously considered evidence of sickle cell anemia, only one of our patients had sickle hemoglobin.