Chronic osteomyelitis of long bones: reasons for delay in presentation

Chronic osteomyelitis is a common orthopaedic infection and a major medical problem in developing countries. Time is a critical factor in the evolution of the chronic disease as most of our cases are a progression from acute haematogenous osteomyelitis. Our patients present very late.

To identify the reasons for this delayed presentation and suggest possible solutions.

Over three years (2000-2003) in a multi-centre study (2000-2003), we prospectively evaluated patients with both clinical and radiological diagnosis of chronic osteomyelitis. Besides personal data, mode of onset, duration of illness, father's educational status and occupation and reasons for delayed presentation were documented using a questionnaire. Previous surgery was an exclusion criterion.

One hundred and thirty-six patients comprising 81 males and 55 females with a mean age of 17.7(2-55) years were recruited. The mean duration between onset of disease and presentation for treatment was 13.3(2-120) months. Sixty-one (44.9%) presented to a health facility were misdiagnosed and inappropriately treated; ignorance was the reason in 37(27.2%) and lack of finances in 32(23.2%). There was no statistically significant association between the father's educational status and occupation and the attitude to hospital attendance.

Misdiagnosis, ignorance and poverty are the reasons for delayed presentation in patients with chronic osteomyelitis in this environment. A high index of suspicion, accurate diagnosis and appropriate therapy offer the only hope in containing the acute phase. Continuing medical education, improvement in social and medical amenities and the national health insurance scheme are possible ways of overcoming undue delay in presentation for specialist consultation.