Fhm. Lauschke et Ct. Frey, HEMATOGENOUS OSTEOMYELITIS IN INFANTS AND CHILDREN IN THE NORTHWESTERN REGION OF NAMIBIA, Journal of bone and joint surgery. American volume, 76A(4), 1994, pp. 502-510
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.