Primary subacute epiphyseal osteomyelitis: a report of three cases

Three patients with primary subacute epiphyseal osteomyelitis are reviewed. All had a history of minor trauma and complained of pain and limp; none was systemically ill. Plain radiographs demonstrated a well-defined lytic lesion in the epiphysis. One case occurred in the distal tibial epiphysis from which pneumococci were isolated; this appears not to have been described previously. Patients were treated with flucloxacillin and two without operative intervention; all recovered completely. Follow-up radiographs at 2-5 years demonstrated healing of the lesions with no evidence of damage to the epiphysis or the joint. There have been 10 previously reported cases in the literature, all treated by antibiotics and curettage. Based on this experience we believe that administration of appropriate antibiotics and immobilisation of the affected limb are sufficient treatment for some children presenting with this condition.