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A comparative study of osteomyelitis and purulent arthritis with special reference to aetiology and recovery

Osteomyelitis und purulente Arthritis. Vergleichsstudie mit besonderer Berücksichtigung von Ätiologie und Heilung

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Summary

We analysed the records of 44 paediatric cases of acute haematogenous osteomyelitis (age 0–14 years) and 25 cases of purulent arthritis (age 0–13 years). The annual incidences were 4.5 and less than two per 100,000 children, respectively. Bacteriologic diagnosis was achieved in 82% of the acute haematogenous osteomyelitis cases and in 40% of the acute purulent arthritis cases.Staphylococcus aureus was responsible for 70% of the proven acute haematogenous osteomyelitis and acute purulent arthritis cases combined, followed by streptococci (20%) andHaemophilus influenzae (7%), which caused only acute purulent arthritis. Acute haematogenous osteomyelitis was localized in the femur in 41% of the cases and acute purulent arthritis in the knee joint in 76%. Surgery (in most cases drilling, fenestration or arthrotomy) was performed on 82% of the acute haematogenous osteomyelitis and on 32% of the acute purulent arthritis patients. Although six of the acute haematogenous osteomyelitis patients (but none of the acute purulent arthritis patients) underwent surgery for a second time, permanent damage, which was functionally non-significant, developed in only 14%. No sequelae were found in the acute purulent arthritis group. The average duration of antimicrobial therapy was 44 days in the acute haematogenous osteomyelitis group and 29 days in the acute purulent arthritis group. The prognosis for the children was similar, irrespective of whether the drugs used were staphylococcal penicillins, ampicillin, lincomycin or clindamycin.

Zusammenfassung

44 Fälle von akuter hämatogener Osteomyelitis und 25 Fälle von eitriger Arthritis bei Kindern (Alter 0–14 bzw. 0–13 Jahre) wurden anhand von Krankengeschichten analysiert. Die jährliche Inzidenz der Osteomyelitis betrug 4,5, die der Arthritis 2 pro 100 000 Kinder. Bei 82% der Erkrankungen an hämatogener Osteomyelitis und bei 40% von eitriger Arthritis wurde eine bakteriologische Diagnose gestellt.Staphylococcus aureus war der verantwortliche Erreger für 70% der gesicherten Infektionen; Streptokokken waren mit 20% der zweithäufigste pathogene Erreger.Haemophilus influenzae wurde nur bei eitriger Arthritis (7% der Infektionen) als ätiologisches Agens identifiziert. Bei 41% der Kinder spielte sich die Osteomyelitis im Femur ab; bei eitriger Arthritis war in 76% der Fälle das Kniegelenk befallen. Ein chirurgischer Eingriff wurde bei 82% der Osteomyelitiden und bei 32% der Arthritiden vorgenommen (in den meisten Fällen wurde aufgebohrt, gefenstert oder die Arthrotomie durchgeführt). Bei sechs Kindern mit Osteomyelitis (bei keinem Fall von Arthritis), war eine Reoperation nötig, doch kam es nur bei 14% der Kinder zu einem bleibenden, aber funktionell unerheblichen Restschaden. In der Arthritisgruppe fanden sich keine Folgeerscheinungen. Die antibakterielle Therapie wurde bei Osteomyelitis im Mittel 44 Tage lang, bei Arthritis 29 Tage lang durchgeführt. Die Kinder hatten eine ähnliche Prognose, unabhängig davon, ob Staphylokokkenwirksame Penicilline, Ampicillin, Lincomycin oder Clindamycin eingesetzt wurden.

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Authors and Affiliations

  1. National Public Health Institute, Vaccine Laboratory, Mannerheimintie 166, SF-00280, Helsinki 28

    H. Peltola M. D.

  2. Orthopaedic Hospital of the Invalid Foundation, SF-00280, Helsinki 28

    V. Vahvanen M. D.

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  1. H. Peltola M. D.
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  2. V. Vahvanen M. D.
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Peltola, H., Vahvanen, V. A comparative study of osteomyelitis and purulent arthritis with special reference to aetiology and recovery. Infection 12, 75–79 (1984). https://doi.org/10.1007/BF01641675

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  • DOI: https://doi.org/10.1007/BF01641675

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