Abstract
We reviewed 600 children with 640 sites of acute haematogenous osteomyelitis treated between 1983 and 2002. Neonates and patients with septicaemia were excluded.
The mean age of the children was 7 years (3 months to 13 years). The male to female ratio was 2.3:1.
The diagnosis was made clinically and with the help of special investigations. The while cell count was elevated in 75% and the ESR in 98%. Blood cultures were positive in 79%. Radiographs showed metaphyseal rarefaction and/or periosteal reaction in 19% and isotope scan was positive in 43%. No aspiration was done to establish the diagnosis. In nine sites (1.5% of operated sites) the diagnosis was regarded as incorrect (no growth or subsequent bony changes on radiographs).
The distal femur was the most common site (25%), followed by the distal tibia (20%), proximal tibia (19%), proximal femur (7%), proximal humerus (5%), forearm (5%), distal fibula (4%), pelvis (4%), calcaneum (3%) and other (8%). Staphylococcus aureus was cultured in 89% of sites.
Treatment was with intravenous cloxacillin, followed by oral flucloxacillin for 6 weeks. Surgery was performed at 94.5% of sites. The 5.5% sites that were not operated upon were in the pelvis or were early limb sites with no swelling. At surgery, 21% of sites were found to have intra-osseous pus. In the remaining 79%, there was subperiosteal pus at 41% of sites and extraperiosteal pus at 38%. Patients were followed up until adequate bone stock was present on radiographs and no sinus or sequestrum was present. Poor results (sequestrum and/ or pathological fracture) occurred in 8.3% (53 sites). Poor results were not site-specific, but 99% occurred in patients with subperiosteal or extraperiosteal pus.
Secretary: Dr H.J.S. Colyn, Editor: Professor M.B.E. Sweet. Correspondence should be addressed to SAOA, Box 47363, Parklands, Johannesburg, 2121, South Africa.
