Sixteen patients with pyogenic osteomyelitis of the ribs are reported; ages ranged from 3 months to 42 years and 10 were female. Right sided ribs were affected in 10 cases and single ribs in 12. Antecedent causes included empyema thoracis (56%) and blunt chest trauma (19%). Fourteen out of 16 patients presented with discharging chest wall sinuses and five patients had associated swellings on the chest wall. The duration of symptoms ranged from two to 36 months. The most common microorganism isolated was Staphylococcus aureus (50%). Rib excision (with drainage of the empyema in two cases) was curative in all 16 cases in this study.Osteomyelitis of the ribs appears to be a rare disease in both the tropical and the temperate areas of the world.13 Adeyokunnu and Hendrickse,4 in a review of 63 cases of salmonella osteomyelitis seen in Nigerian children, found no case of rib osteomyelitis. Similarly, Dich et al1 reviewed 163 cases of osteomyelitis in infants and children over 15 years and found only one case (0.6%) affecting the ribs.Osteomyelitis of the ribs has been found in association with childhood empyema, -7 Staphylococcus aureus infection,1 sickle cell anaemia, and infection due to Salmonella and Klebsiella species and Proteus rettgeri.3 Osteomyelitis arising in ribs adjacent to sites of intubation in the chest in children with empyema has been documented by Osinowo et al.7 The present report reviews 16 cases of rib osteomyelitis treated by our cardiothoracic unit over seven and a half years. From this experience and a review of the published reports we consider the aetiology, pathogenesis, clinical presentation, and results of treatment of the disease. MethodsThe records of all patients with rib osteomyelitis admitted to the unit from January 1975 to May 1983 formed the basis of this prospective study.The data extracted from each patient's record included the age, sex, clinical presentation, radiological findings, mode and results of treatment, and the results of bacteriological and routine haeAddress for reprint requests: Dr 0 Osinowo,