Chronic Osteomyelitis in Patients Who Have Haemoglobinopathy

Chronic osteomyelitis in patients who have haemoglobinopathy remains a major cause of prolonged morbidity in the developing world. The problem of recurrent chronic osteomyelitis remains unresolved and there has been no consensus on the optimal method of treatment. We have prospectively evaluated our treatment modalities so as to highlight the outcomes. In a 4-year period we had 60 consecutive patients with chronic osteomyelitis. Forty of them had normal haemoglobin (HbAA) and the remaining 20 who had haemoglobinopathy were studied. Fifteen of them had sickle cell trait (HbAS) and five had sickle cell anaemia (HbSS). There were 30 bone infection sites (20 in HbAS and 10 in HbSS). The male to female ratio was 1.5:1. The mean age was 12 years. Discharging sinuses, massive sequestrum and involucrum were the common presentations. The mean duration of infection was 4 years. Haematogenous osteomyelitis was the major predisposing factor in more than 83% of cases.Staphylococcus aureus was the most common isolate, 57.14% of isolates. No salmonella species were isolated. The femur was the most frequently involved bone site, 50% of cases. A combination of saucerization sequestrectomy, curettage, primary wound closure and culture specific enteral or parenteral antibiotic therapy was the preferred method of treatment. The outcome was good, but recurrent chronic osteomyelitis was the major factor responsible for prolonged morbidity in 4 patients. We observed that were no major differences between HbAS and HbSS patients in terms of the clinical manifestation of chronic osteomyelitis. We advocate a combination of repeated surgical debridement and culture specific antibiotic therapy as the panacea for recurrent chronic osteomyelitis in our setting. Key Words:Haemoglobinopathy, Recurrent Osteomyelitis, Surgical Debridement, Primary Closure, Nigeria . Nig. Medical Practitioner Vol. 44(5/6) 2003: 92-9