Management of subacute acetabular osteomyelitis in a child

Clinical manifestations of subacute osteomyelitis may lead to delayed diagnosis. Acetabular subacute osteomyelitis is an uncommon disease. Bone tumors are usually suggested first. Diagnosis is often made based on radiological findings. We report on the case of a 9-year-old girl who consulted at the emergency department because of limping and pain in her left limb lasting 2 weeks. No fever was reported. Physical examination found a clear, painful reduction in hip mobility. X-ray findings revealed a posterior loss of bone in the acetabular wall. MRI found a mild invasion of the periarticular hip joint and muscles. The surgical exploration of the hip found a collection in the posterior acetabular wall suggesting septic disease. Bacteriological and pathological exams confirmed acetabular subacute osteomyelitis. Nine months after surgery, antibiotic therapy, and physiotherapy, the patient was painless and the hip mobility showed near normal values with a reduction in external rotation and flexion. The aim of this case report is to review the characteristics of subacute acetabular osteomyelitis, including therapeutic modalities, underlining surgical debridement as a rule for both diagnosis and treatment.