Experience of managing acute osteomyelitis in a district general hospital

Abstract

Introduction A cute Osteomyelitis (AO) is a suppurative bone infection caused by haematogenous spread within the metaphysis of long bones. Unlike septic arthritis, children with AO are usually systemically well and the classic text book description of fever, swelling and limp is often absent. Prompt diagnosis and treatment is important to avoid complications such as growth arrest, septic arthritis and chronic infection. Objective 1) To review the clinical presentation and value of laboratory and radiological investigations in diagnosing Acute Osteomyelitis; 2) To review current treatment of Acute Osteomyelitis and follow up of patients for complications. Method We retrospectively reviewed case notes of 12 children who were diagnosed with acute osteomyelitis over a two year period. Results Temperature of 38 degrees and above was present only in one third of patients whereas loss of function and pain were present in all the patients. Recent infection or trauma was present in most of the cases. An elevated ESR (>35 in 10 patients) and high platelet count (>400 in 11 patients) were the most consistent laboratory results. CRP was less than 15 in 3 patients. Blood cultures were negative in all but one case where group B streptococcus was isolated in a neonate from blood and aspiration of joint. MRI was helpful in confirming equivocal diagnosis. Bone scan when done in 4 cases helped in diagnosing AO. Flucloxacillin was an effective antibiotic in the majority except for neonatal osteomyelitis. 6 children received antibiotics for 42 days, 1 child for 5 days and 1 for 70 days, the rest received antibiotics for 14 days. Intravenous antibiotic treatment duration was very variable and was guided by resolution of inflammatory markers to normal levels. Antibiotics was started on the 12th day of presentation for a baby and 3 en had complications where one child required a sequestrectomy, one developed a Brodie9s abscess and one developed chronic recurrent multifocal osteomyelitis. Conclusions Acute osteomyelitis still remains a difficult diagnosis. A high index of suspicion together with a combination of clinical signs, laboratory and radiological tests are essential to facilitate prompt diagnosis and treatment to avoid long term complications. Good team working, information sharing and communication with our orthopaedic colleagues is essential to reduce morbidity and improve quality of care.