HEMATOGENOUS OSTEOMYELITIS OF THE FEMORAL-NECK IN CHILDREN

Thirty-six cases of upper femoral osteomyelitis in 35 children were re viewed after a mean follow-up of 65 months to assess the influence of surgical decompression of the septic joint on the incidence of the epi physeal necrosis, to discuss treatment of complicated cases, and to de termine why an osseous lesion of the femoral neck carries a bad progno sis for outcome. The incidence of epiphyseal necrosis was approximatel y the same in group I cases (12 hips) in which articular decompression had been performed during the acute phase of the disease (50%) and in group 11 cases (24 hips) in which no arthrotomy had been performed (5 3.8%), when cases with other complications (dislocation, fracture, or slipped epiphysis) were excluded from analysis. The results suggest th at the epiphyseal necrosis was caused mainly by subperiosteal abscess when it developed at the posterosuperior aspect of the femoral neck. T reatment of the 25 complicated cases resulted in 20 stable hips (after conservative treatment in 19 and surgical treatment in one). The bad prognosis for outcome carried by osteomyelitis of the femoral neck is due to the metaphyseal abscess that causes development of avascular ne crosis (AVN) and to the complications that can be prevented with conse rvative treatment.