Abstract
A retrospective study was undertaken in our unit to investigate any change in osteomyelitis trends in the last ten years (1991-2001). These results were then compared to 3 previous studies conducted by our unit on childhood osteomyelitis, 1977-1979 45 cases(O’Brien et al)1, 1980-87 (84 cases) and 1988-1991 (54 cases).
149 patients were identified from hospital discharge database with a diagnosis of osteomyelitis between 1991 and 2001. 136 fully completed charts were discovered and included in the study. 22 children did not fulfil the criterion for the diagnosis of acute or subacute osteomyelitis and were excluded. Cellulitis was the actual diagnosis 18/22 cases, leukaemia or other neoplasm in 4/22 cases. 28% of the children 32/114 had acute haematog-enous osteomyelitis with classical signs and symptoms the remaining 72% fell into the subacute osteomyelitis category as described by Gledhill. Table 1 shows the comparison between the 4 studies.
89% of patients underwent 3 phase bone scanning, and 90% of these were positive. Blood cultures were performed in 87% of patients and were positive in 8.5%, 2 patients being positive and symptomatic of Nesseria meningitis, 4 Staph aureus, 2 Strep Pneumonia, 1 staph epidermidis and 1 E.Coli. As compared to previous 3 studies no case of haemophilus influenza type B was encountered. Aspiration was performed in 22 patients and 18 demonstrated bacteria, the two commonest pathogens were Staphylococcus aureus 66% and epider-midis 16%. 8 patients underwent surgical debridement or drilling if clinically septic or because of failure to improve despite medical treatment.
Initial antibiotic treatment comprised of i.v. penicillins and oral fucidin in 92% of patients, the remainder receiving cephalosporins as favoured by physicians or erythromycin if history of hypersensitivity. Antibiotics arethen tailored to clinical picture or culture results. Table 2 shows the changing duration pattern of antibiotic administration.
There were four cases of complications, 2 cases of chronic osteomyelitis and 2 cases of limb shortening both around the knee joint.
Our results correlate well with other authors. Surgery has an ever-decreasing role in the management of osteomyelitis, with conservative antibiotic management and splintage being the treatment of choice. Subacute osteomyelitis is an ever-increasing entity as reflected in other studies. The incidence of osteomyelitis presenting to our unit has fallen to 2.34 per 10000 per yea. A possible explanation may lie in altered host pathogen interactions, increased host resistance, the frequent administration of broad-spectrum antibiotics in general practice. Increased population wealth as experienced in Ireland in the last 8 years may also have a role.
Local Host: British Society for Children’s Orthopaedic Surgery. Conference Theme: Congenital Deficiencies of the Lower Limb. These abstracts were prepared by A.Catterall.
