HEMATOGENOUS OSTEOMYELITIS IN INFANTS AND CHILDREN IN THE NORTHWESTERN REGION OF NAMIBIA

We reviewed the records of fifty-five children, including eleven infan ts (three of whom were neonates), who had at least one skeletal manife station of hematogenous osteomyelitis. Forty-two of the patients were boys and thirteen were girls. The patients were classified into three groups: those who had early acute, those who had late acute, and those who had chronic osteomyelitis. This classification system was based o n clinical and radiographic criteria. Seven patients had early acute o steomyelitis; eighteen, late acute osteomyelitis; and thirty, chronic osteomyelitis. The bones most often affected were the tibia (twenty-tw o patients) and the femur (nineteen patients). Penicillin-resistant St aphylococcus aureus grew on culture of specimens of purulent material from twenty-nine (76 per cent) of thirty-eight patients. Escherichia c oli, Proteus mirabilis, and Enterobacter grew on culture of specimens of purulent material from one patient each. Six cultures showed no gro wth. No purulent material was obtained from seventeen of the fifty-fiv e patients. The seven patients who had early acute osteomyelitis, and four of the eighteen patients who had late acute osteomyelitis, respon ded well to antibiotic treatment only. A combination of antibiotic and operative treatment was needed in fourteen of the eighteen patients w ho had late acute osteomyelitis and in all thirty patients who had chr onic osteomyelitis. Forty-nine of the fifty-five patients were followe d for two years; the remaining six patients were lost to follow-up. Th e two-year results were good in nineteen of the twenty-three patients who had acute (early or late) osteomyelitis and in fifteen of the twen ty-six patients who had chronic osteomyelitis. The results were satisf actory in five of the twenty-six patients who had chronic osteomyeliti s; these patients had a deficit in bone-healing, a deficit in calcific ation, or slight functional impairment. The results were poor in four of the twenty-three patients who had acute (early or late) osteomyelit is. In three of these four patients, the poor results were due to the development of chronic osteomyelitis, with draining sinuses in two of them, osteolysis of the femoral head in one of the two, and severe ost eolysis of the tibia in the third. In the fourth patient, a 20-degree valgus deformity of the knee developed because of necrosis of the late ral femoral condyle; this was seen six months after drainage of a sept ic effusion in the knee, done at the age of three weeks. The results w ere poor in six of the twenty-six patients who had chronic osteomyelit is. Four of these six patients had a poor result because of a recurren ce of osteomyelitis with draining sinuses in the region of the thigh ( two patients) or below the knee (two patients) with tibial sequestrati on. The other two patients had a poor result because of shortening of the limb, which was due to necrosis of the femoral head in one patient and was secondary to transposition of the fibula in the other.