Treatment of subacute osteomyelitis in childhood

Abstract

A protocol for the treatment of subacute haematogenous osteomyelitis has been used and evaluated in 71 children. A group of 26 children with a radiologically "aggressive" lesion had biopsy followed by antibiotics and immobilisation for six weeks. A group of 45 children with 48 cavities in the metaphysis or the epiphysis or both was further subdivided according to the presence or absence of clinical signs of pus at subperiosteal level or in a joint. Children with evidence of pus had operation followed by antibiotics and immobilisation while the remaining children were treated similarly but without operation. Intravenous cloxacillin or flucloxacillin and benzylpenicillin were given in hospital for 48 hours and oral antibiotics and immobilisation were then continued at home for six weeks. Staphylococcus aureus was the only pathogen cultured. In all, 91% were cured by a single course of treatment. Of the 48 metaphysial and epiphysial lesions, 77% were treated without operation; and of these, 87% were cured by a single course of treatment, this figure reaching 94% in children under 11 years old.

Subacute physeal abscess: case report to illustrate treatment with a minimally invasive incision and drainage technique

“…However, it has been reported that healing with radiological changes takes place over 6-12 months. 1 Our patient was clinically well at the six-month, one-and two-year follow-up visits with no leg length discrepancy seen. Further radiological investigation was therefore deemed unnecessary.…”

“…6 Ross and Cole reported 24 cases with both metaphyseal and epiphyseal lesions. 1 Initial curettage with six weeks of antibiotics was performed in four cases, for formation of subperiosteal pus, extension into the adjacent joint or diagnostic purpose. Of the 20 treated conservatively with 6 weeks of antibiotics, 2 had late surgical curettage for failure to respond to antibiotics.…”

Primary subacute haematogenous osteomyelitis in children

“…Metaphyseal lesions are the most common and occur mainly in the tibia. 1,2,4,6,7,13 Type 1a is a punched-out localised zone of lucency and can mimic forms of histiocytosis especially an eosinophilic granuloma. Type 1b resembles a typical Brodie's abscess with dense sclerotic margins and may be mistaken for an osteoid osteoma.…”

“…20 There have been several recent reports of the epiphyseal form of the condition (type V) which, however, remains rare. 2,6,13,16,21 The lesions appear as a central lucency, with a faint sclerotic margin and may resemble a chondroblastoma. They usually occur within the epiphysis in children less than six years old and do not cross the epiphyseal plate.…”

“…In previous reports either the primary form has not been distinguished from that modified by antibiotics 6,10,12,13 or both adults and children have been included. 1,2,5,6,9 King and Mayo 2 described the disease as following an indolent course because of host resistance combined with low virulence of the infecting organism.…”