The Journal of Bone and Joint Surgery, Vol 73, Issue 9 1281-1294, Copyright © 1991 by Journal of Bone and Joint Surgery, Inc
Osteomyelitis in patients who have sickle-cell disease. Diagnosis and management
CH Epps, DD Bryant, MJ Coles and O Castro
Division of Orthopaedic Surgery, Howard University Medical Center, Washington D.C.
Fifteen patients who had sickle-cell disease and osteomyelitis (affecting
thirty bones) were treated with operative decompression and parenteral
administration of antibiotics between 1973 and 1988. Organisms were
isolated on culture of specimens of bone from all fifteen patients.
Parenteral antibiotic therapy was continued for a minimum of six weeks
after operative decompression. The osteomyelitis resolved in twenty-nine
(97 per cent) of the thirty affected bones after follow-up ranging from two
to fifteen years. With their compromised immune status and poor circulation
of blood in bone, patients who have sickle-cell disease and osteomyelitis
are prone to have complications. In our series, the complications included
an adhesive pericapsulitis of the shoulder in two patients, avascular
necrosis of the humeral head in one, and a pathological fracture of the
femur in one. In four of the fifteen patients, chronic osteomyelitis
persisted, but in three of the four, the infections of bone healed six to
fourteen months after the initial operative decompression. Staphylococcus
aureus was isolated on culture of specimens of bone from eight to the
fifteen patients; Salmonella, from six; and Proteus mirabilis, from one.
Although Salmonella has been cited as the principal causative organism of
osteomyelitis in patients who have sickle-cell disease, in our experience
Staphylococcus aureus was the most common infecting organism. Therefore,
Salmonella may not be the most common cause of osteomyelitis associated
with sickle-cell disease in all countries or in all areas of a particular
country.
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