THE INCIDENCE OF OSTEOMYELITIS IN CHILDREN. A 10-YEAR EXPERIENCE OF OUR CLINIC

Abstract

The purpose of our study is to report the incidence of osteomyelitis during the last 10 years in our department. Diagnosis, management and follow-up are also discussed.

We carried out a retrospective study on 40 children who were hospitalised in our clinic between the years 1995–2006 suffering from osteomyelitis. There were 29 male and 11 female children with a mean age 6.8 years. A full blood count, CRP, ESR were measured and X-rays and ultrasound were performed in all patients. Blood cultures were also taken. Additionally, bone scan and CT scan were also performed in 6 and 3 children respectively. The lesion involved in 7 cases the tibia, 9 cases the lower end of the femur and the knee joint, 4 cases the head of the femur and the hip, 7 cases the patella, 4 cases the neck of the humerus, 3 cases the lower end of the fibula, 3 cases the 5th finger of the hand, 2 cases the 4th and 5th metatarsal bones and in 1 case the clavicle. All patients were initially commenced to double antibiotic scheme iv. The microorganisms isolated were Staphylococcus Aureus (27 children-67.5%), Pseudomonas Aeruginosa (9 children-22.5%), Streptococcus Pneumoniae (4 children-10%)

The majority of children (80%) were managed conservatively with intravenous and then oral antibiotic therapy. In 8 cases (20%) surgical debridement was performed due to persisting symptoms and/or aggressive radiologic appearance of the lesion. The mean days of hospitalisation were 17.4 days/patient. A 1.2 year mean follow-up was achieved in all the above patients. All children gradually improved and became pain free, while complete bone resolution appeared in the X-Rays.

Staphylococcus aureus remains the most common organism causing acute osteomyelitis. If left untreated the condition can lead to serious sequelae. The optimal approach in uncomplicated cases may be a combination of aspiration for diagnostic purposes and prolonged antibiotic therapy. A patient’s lack of response to antibiotic treatment and evidence of aggressive radiologic features are indications for surgery.