Treatment of complicated childhood osteomyelitis at Yopougon University Hospital, Abidjan (Côte d'Ivoire)]

Complicated osteomyelitis in children is difficult to treat and can lead to important functional sequelae.To report epidemiological, clinical and diagnostic aspects as well as treatment and outcome of complicated osteomyelitis in children.This retrospective study of complicated osteomyelitis cases treated from March 2000 through March 2004 in the orthopedics unit of the Yopougon University Hospital in Yopougon identified 42 children with complicated osteomyelitis (defined as all acute osteomyelitis lesions that developed any complications). We examined the following types of variables : epidemiologic (age, sex, ethnic origin), clinical (fever, type of complication), diagnostic (full blood count, C-reactive protein, bacteriological, radiological) treatment (antibiotic treatment, surgical and orthopedic treatment), and outcome (cure, sequelae).The sex-ratio was 1:1, and mean age at first consultation in our specialized unit was 7 years and 5 months. Thirty per cent of the children were referred from the haematology unit. The ethnic origin of 60% was Malinke (northern Côte d'Ivoire). Time from initial signs to first consultation in our unit averaged 7 months and ranged from 5 days to 5 years. Fever of 38.5 degrees C or higher was reported for 60% of the children; 32 children (76%) presented osteomyelitis fistula, 10 (24%) osteomyelitis without fistula, and 10 a hemoglobinopathy. Radiography revealed pathological fractures in 13 (31%) cases, sequestrum in 17 (41%), and diaphysitis in 12 (28%). Lesions were found predominantly on the femur and humerus. Staphylococcus aureus and Salmonellae spp. were the principal bacteria involved. Third-generation cephalosporins were combined with aminoglycosides for 19 cases (60%) of osteomyelitis fistula and 3 cases (30%) of febrile osteomyelitis without fistula. Surgical treatment was fistulectomy in 94% of the cases of osteomyelitis fistula and sequestrectomy in 47%. More than half the pathological fractures were treated by immobilization in plaster, and sequestrum was restored by immobilization in plaster in 7 cases. The principal sequela was axial displacement of the limb.Complications of acute osteomyelitis are most often caused by diagnostic errors that delay treatment. Surgical treatment of the two principal lesions (fistula and bony sequestrum) followed by combination antibiotic therapy and completed by immobilization in plaster ensures complete recovery in more than half the cases.