Roentgenographic Changes in Bone Infections Treated with Penicillin

Abstract

The recent generalized use of penicillin has stimulated interest in the treatment of infections of all types with this biological agent. We have had the opportunity of using penicillin in approximately 25 cases of bone infection, both acute and chronic, with varying results. In general, the period of active infection has been shortened and the clinical results have been gratifying. The following case summaries and illustrations demonstrate what we believe to be the typical changes occurring in bone infections susceptible to treatment with penicillin. Certain of these cases represent old chronic infections, and in these the response was by no means dramatic, although in the majority there was a decrease in drainage, with improvement in the general physical condition of the patient. In some of the cases it was possible to do elective surgery concurrent with the administration of penicillin, with no extension of the infection. In the acute cases which proved susceptible to penicillin, clinical improvement preceded the roentgenographic signs of healing, and the patient became clinically well. We do not feel that it is by any means established that in bone infections treatment with penicillin is a substitute for adequate drainage, when necessary, or for other surgical procedures which have proved of benefit in the past. In a few of these cases the clinical response was so rapid that surgical drainage was not instituted. Not all of the patients showed a prompt response to the penicillin, but in those which did, certain bone changes occurred. Case Reports Case I: E. M. B., an 11-year-old boy, was admitted to the clinic March 14, 1944, with pain in the right knee of three days' duration. Examination showed tenderness over the upper fourth of the right tibia with a slight soft-tissue swelling below the medial condyle anteriorly. There was a slight increase in joint fluid, and motion in the knee was guarded and painful. The temperature on admission was 101°, the white blood count 14,000; urinalysis showed ketone bodies. The roentgenograms were negative (Fig. 1, A). The administration of penicillin was instituted on admission: 1,000,000 units were given intramuscularly, 10,000 units every three hours. The patient's temperature rose to 103° on the first day, and until the fourteenth day it continued to show an afternoon elevation to as high as 102°. It then returned to 98.6° and remained normal thereafter. Roentgenograms made March 24, after 800,000 units of penicillin had been given, showed a localized area of rarefaction in the tibial shaft adjacent to the epiphyseal line (Fig. 1, B). The patient was discharged from the hospital on the fifteenth day, with a normal temperature and a leukocytosis of 12,800. The upper end of the tibia was painless.