Clinical Observation of Hematogenous Osteomyelitis of Fibula in Children

Kim, Key Yong; Kim, Yung Tae; Seo, Jai Gon; Lee, Joong Myung; In, Ki Young

Abstract

Recently, the incidence of hematogenous osteomyelitis tends to increase dse to abuse of the antibiotics and resistent organisms to antibiotics. The three main causes of complication to be chronic stage in hematogenous osteomyelitis were failure of early diagnosis, inadequate choice of antibiotics with insufficient duration and insufficient surgical intervention. Furthermore, hematogenous osteomyelitis of fibula in children has low incidence, so the possibility of chronicity is able to be increased because of delayed diagnosis and inadequate treatment. During the period of 10 yesrs extending from 1977 to 1986, we have treated 12 cases of hematogenous fibular osteomyelitis in children and clinical analysis was made about comparison with prevalent hematogenous osteomyelitis of distal femur or proximal tibia. The following results were obtained; 1. The incidence in males was 1.4 times grester than females. 2. The incidence of involved sites was 2 times dominant in Rt, and all cases were observed in proximal and distal metaphyseal area of fibula. 3. Clinical symptomes and signs were pain, local heat, redness and local tenderness in all of acute cases and 70% of chronic cases with sinus formation and pathologic Fx. 4. ESR was elevated to average 42 mm/hr in all acute cases highestly, but highest leucocytosis was observed in subacute case. 5. Definite bone changes in radiologic findings was observed in only subacute and chronic cases, and uptake of radioisotope in bone scan was observed in 2 acute cases, which were all performed. 6. Causative organism was only staphylococcus aureus, and high sensitive antibiotics to taphylococcus aureus were Cephalosprin, Cloxacillin, Amikin and observed resistance to penicillin(82.5%) and tetracycline(82.5%). 7. Early diagnosis, adequate antibiotic choice with sufficient duration and early surgical decompression and drainage were considered to be essential part of management of hematogenous fibular osteomyelitis and preventing its chronicity.