Acute haematogenous osteomyelitis in children is relatively uncommon but delay in diagnosis and inadequate treatment can result in significant morbidity. Most recently evidence has suggested conservative treatment with adequate antibiotic therapy should be the mainstay, with provision for surgical intervention in those who fail to respond to conservative management. The outcome of primary management has been evaluated in this review. Retrospective analysis of an osteomyelitis database was conducted on individuals presenting to Auckland’s Starship and Middlemore Hospital with an ICD-10 diagnosis of Osteomyelitis between January the 1st 1999 and December the 31st 2008. 813 children fulfilled the criteria for inclusion into this review. The annual incidence of acute haematogenous osteomyelitis in the paediatric population in Auckland over this period was approximately 1:4,000. 64% were male and 36% were female. The majority were New Zealand European (35%), with the other significant ethnic groups represented being New Zealand Maori (22%), and Pacific Island (30%). 23% of patients were aged less than three. 51% of patients were between three and ten, and 26% older than ten. Only 32% had an elevated white cell count on admission. A responsible pathogen was isolated in 50% with the most common being Staphylococcus aureus, which was isolated in 77% of this group. Diagnosis was made radiologically in 66%, clinically in 27%, and surgically after exploration in 7%. The most common site of osteomyelitis was the femur in 254 individuals, followed by the tibia in 198 individuals. 49 had multi-focal involvement. Flucloxacillin was the most common antibiotic used, with 510 individuals being administered flucloxacillin at one point in time during their management. The average length of treatment was 43.7 days, which included intravenous therapy of 22.3 days, and oral therapy of 21.4 days. 60% had a range of duration of therapy from greater than three weeks through to six weeks. 44% required surgical intervention. The relapse rate was 6.8%. The average duration till relapse was 5.8 months. Only 1.7% of the total population went on to develop chronic osteomyelitis. The incidence of paediatric acute haematogenous osteomyelitis in this population appears to be relatively high. The average length of treatment was longer than that now reported to be successful for eradication. This could possibly be a factor in the relatively low rate of relapse and low subsequent rate of chronic osteomyelitis.
The period of time acute orthopaedic patients await surgery at Middlemore Hospital is of concern to a number of the Health Professionals involved in their care. This study has arisen out of that concern in an attempt to quantify the extent of these delays. Every patient operated on at Middlemore Hospital between 01 June and 31 December 2002 who had a fracture that fell within the categories studied was analysed. The six categories analysed were: compound fractures, tibial shaft fractures, femoral shaft fractures, ankle fractures, neck of femur fractures and distal radial fractures. Data regarding the age and time to surgery for each patient was analysed and compared with established guidelines. For the patients with neck of femur fractures additional data regarding their medical fitness for theatre was also analysed. The study showed there was significant delay in acute patients receiving operative treatment at Middlemore Hospital. Furthermore the study highlighted the large volume of acute patients presenting to Middlemore Hospital. Further investigation should be undertaken to consider how a department such as Middlemore can provide operative treatment within an acceptable timeframe to nearly 6000 orthopaedic patients a year, while still providing timely surgery for elective patients.
