The clinical pattern of chronic pyogenic osteomyelitis in a Nigerian community

Fifty-six cases of chronic pyogenic osteomyelitis encountered over a period of 1 year (1976-1977) were analysed. Males were more often affected than females. The sex ratio was 1.4:1. However, within the specific age group of 5-15 years, the sex ratio was reversed, more females were affected and the bones of the lower extremity were more often affected. Of these, the proximal end of the tibia was more involved than the distal end. The lower end of the femur was the second more commonly affected bone. Infections of the skull and spine were not encountered. Haematogenous spread of infection was common. The onset of infection was either acute or subacute. Penicillin-resistant Staphylococcus aureus was the major organism implicated (50%). Mixed infection was common (23%). A striking feature found in this study was the absence of Salmonella infection in sickle-cell disease patients with chronic osteomyelitis. Gross forms of the disease with massive sequestra and involucra, and widespread destruction of bone were common. Trauma in the form of insect bites, minor cuts, thorn-pricks, open fractures, and surgical operations constituted the aetiological factors.