We reviewed the records of fifty-five children, including eleven infants (three of whom were neonates), who had at least one skeletal manifestation of hematogenous osteomyelitis. Forty-two of the patients were boys and thirteen were girls. The patients were classified into three groups: those who had early acute, those who had late acute, and those who had chronic osteomyelitis. This classification system was based on clinical and radiographic criteria. Seven patients had early acute osteomyelitis; eighteen, late acute osteomyelitis; and thirty, chronic osteomyelitis. The bones most often affected were the tibia (twenty-two patients) and the femur (nineteen patients). Penicillin-resistant Staphylococcus aureus grew on culture of specimens of purulent material from twenty-nine (76 per cent) of thirty-eight patients. Escherichia coli, Proteus mirabilis, and Enterobacter grew on culture of specimens of purulent material from one patient each. Six cultures showed no growth. No purulent material was obtained from seventeen of the fifty-five patients. The seven patients who had early acute osteomyelitis, and four of the eighteen patients who had late acute osteomyelitis, responded well to antibiotic treatment only. A combination of antibiotic and operative treatment was needed in fourteen of the eighteen patients who had late acute osteomyelitis and in all thirty patients who had chronic osteomyelitis. Forty-nine of the fifty-five patients were followed for two years; the remaining six patients were lost to follow-up. The two-year results were good in nineteen of the twenty-three patients who had acute (early or late) osteomyelitis and in fifteen of the twenty-six patients who had chronic osteomyelitis. The results were satisfactory in five of the twenty-six patients who had chronic osteomyelitis; these patients had a deficit in bone-healing, a deficit in calcification, or slight functional impairment. The results were poor in four of the twenty-three patients who had acute (early or late) osteomyelitis. In three of these four patients, the poor results were due to the development of chronic osteomyelitis, with draining sinuses in two of them, osteolysis of the femoral head in one of the two, and severe osteolysis of the tibia in the third. In the fourth patient, a 20-degree valgus deformity of the knee developed because of necrosis of the lateral femoral condyle; this was seen six months after drainage of a septic effusion in the knee, done at the age of three weeks. The results were poor in six of the twenty-six patients who had chronic osteomyelitis. Four of these six patients had a poor result because of a recurrence of osteomyelitis with draining sinuses in the region of the thigh (two patients) or below the knee (two patients) with tibial sequestration. The other two patients had a poor result because of shortening of the limb, which was due to necrosis of the femoral head in one patient and was secondary to transposition of the fibula in the other.
