This seven-year old arrived at CEML Hospital draining pus from the outside length of his thigh. This drainage, accompanied by painful walking, began about two months ago and persisted in spite of oral antibiotic therapies prescribed at various health posts. He has no history of trauma, and his growth and development were normal prior this illness. His diet is chiefly corn meal and vaccination history is uncertain.
What do you discern on this X-ray of his hip and femur? Several important finding appear. The femoral head, normally round and fitting snugly into the acetabulum, is destroyed. The shaft of the femur has multiple low-density “holes,” And, the lower shaft and its periosteum is much thicker than normal, especially inferiorly.
What is your diagnosis? Throughout southern Africa, osteomyelitis is tragically common, and in children is usually via hematogenous dissemination rather than trauma. Research is lacking, but sickle cell disease, malnutrition and malaria appear to be consistent risk factors.
How would you treat this child’s pelvic/femoral osteomyelitis? A prolonged course of oral antibiotic alone is not effective. The infected bone must be surgically debrided, drained well, and followed by antibiotic therapy.
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