OSTEOMYELITIS IN INFANTS

¹ Children's hospital, Los Angeles

1. Acute hematogenous osteomylitis in infants runs a rapid course. The correct diagnosis is often made late, after irreparable damage to joint components and growth centers has already taken place.

2. Normal temperature and absence of general reaction to infection are often misleading. This disease should be suspected if an infant becomes irritable and if swelling, tenderness, or loss of function of an extremity develop.

3. There is little controversy concerning the general treatment of the sick infant, but the present tendency is to pay too little attention to the local bone and joint lesion.

4. The intra-articuler tension and lytic action of pyogenic exudate in pyarthrosis of the hip rapidly destroy cartilage, thus causing disruption of the joint, pathological dislocation, and serious growth disturbances which result in severe crippling.

5. In those dislocated hips which were later observed at open operation it was found that internal rotation was necessary to place the remaining elements of the proximal end of the femur into the acetabulum.

6. The chief fault in present-day treatment is the tardiness of surgical drainage of localized abscesses, particularly when a hip joint is involved. Study of this series suggests that early surgical drainage, followed by traction in abduction and particularly with internal rotation, would have minimized absorption of cartilage and saved some of these hips.

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