ACUTE HEMATOGENOUS OSTEOMYELITIS

Abstract

One hundred and thirty-eight cases of acute osteomyelitis admitted to Babies Hospital between 1930 and 1946 are the subject of this report. An unexpected number of cases resulted from infection by hemolytic str. The behavior of hemolytic Staph. aureus is compared to hemolytic str. in osteomyelitis. Mortality is greatest with extreme youth, chronicity least with youth.

Massive doses of penicillin in the earliest stages of the disease constitutes the treatment of choice and emphasis should be on the "treatment of the child," rather than treatment of the bone. Surgery should be postponed in the early stages and used later only to drain abscesses of the soft parts or abscesses of the bone which are well localized and not regressing.

The treatment of chronic osteomyelitis is an entirely different problem. Radical removal of diseased bone and sinuses with primary closure of the wound is the treatment of choice. Immobilization, penicillin, and obliteration of dead spaces by the use of muscle and skin grafts are important adjuncts to success.