Acute haematogenous osteomyelitis in Nigeria

Acute haematogenous osteomyelitis formed less than a quarter of the 125 consecutive cases of osteomyelitis seen by the authors and followed up for a minimum of six months and an average of one year and four months. Of the twenty-nine cases of acute osteomyelitis a third occurred in patients with normal haemoglobin genotype (AA); a third of homozygous S disease (SS disease) and sickle cell haemoglobin C disease (SC disease); a quarter in sickle cell trait (AS) and haemoglobin AC trait, while in the remaining cases the haemoglobin genotype was not known. The sex incidence was equal, and children aged 1 to 15 years predominated. Most patients presented late with florid disease. Gram negative bone infection and multiple, entire diaphysial involvement were significantly commoner in SS and SC disease than in the other haemoglobin genotype. There was a high incidence of resistance of the infecting organisms to the commonly available antibiotics. Treatment was mostly conservative. There were no deaths, but the incidence and severity of complications were quite high. The significance of these results are discussed and the need for establishing the sensitivity of the infecting organism in every case and for early surgical exploration in non-sicklers are stressed.