Osteomyelitis of the clavicle. A case report.

Osteomyelitis of the clavicle is a rare complication of subclavian vein catheterization. The authors report the case of a patient with osteomyelitis in the right clavicle after subclavian venipuncture.     

Osteomyelitis of the sacrum

The authors had 11 patients of different age with osteomyelitis of the sacrum; 9 were males and 2 females. The process was unilateral in most (9) of them. The duration of the disease was approximately 4 months. Before admission to the clinic 8 patients were treated for a long time and unsuccessfully by other specialists. From their experience the authors describe the characteristic complaints, signs, and clinical picture of the disease. They suggest that modern methods of examination (scintigraphy of the skeletal bones, computerized tomography) should be used more frequently. These methods ensure earlier and more reliable detection of destruction of the sacrum and leakage of pus. The 11 patients were operated on. One patient died on the 11th postoperative day from thromboembolism of the pulmonary artery. The disease did not recur in any of the patients who recovered.     

Osteomyelitis of the acetabulum

The authors describe an 11-year-old boy with hip pain in whom septic arthritis was first suspected. Radionuclide scintigraphy demonstrating increased uptake in the acetabulum led to the diagnosis of osteomyelitis. In the case presented, the value of bone scanning with careful interpretation of even minimally increased uptake and the usefulness of repeated evaluation is demonstrated.     

Osteomyelitis of the Spine

A study of a series of 82 cases of pyogenic osteomyelitis of the spine has shown that the clinical features at the initial stage of the disease often present such a varied picture that the correct diagnosis may easily he overlooked for a long time. Once radiographic changes are demonstrated, the primary consideration in differential diagnosis is tuberculous spondylitis. Bacteriological verification by needle biopsy or surgical exploration is recommended in order to institute an adequate antibiotic therapy. Surgical evacuation is advocated in cases with extensive vertebral destruction. The majority of patients recovered within 1 year from the onset of illness. in slightly more than half of the cases the spinal lesions healed with spontaneous interbody fusion. This tendency was most pronounced in cases of cervical and upper thoracic involvement. No deaths occurred as a result of the spinal disease.     

Osteomyelitis of the foot

A favorable outcome was obtained in the case of an infected diabetic ulcer that resulted from neglect. The importance of appropriate antibiotic therapy and the advantage of a newer generation cephalosporin, cefamandole nafate (Mandol), is discussed. Optimal diagnostic information relative to the presence of osteomyelitis may be obtained by concomitant use of conventional radiographic technique and bone scanning. The most complete information concerning the status of diabetic control is gained by evaluation of standard blood glucose levels in conjunction with glycosylated hemoglobin A1C.     

Osteomyelitis of the patella

Osteomyelitis of the patella is an uncommon infection that is primarily a disease of childhood. The diagnosis frequently is delayed because of its rarity and variable presentation, which may be acute with systemic signs or insidious with mild local signs. The diagnosis should be considered in patients with persistent peripatellar pain and swelling, cellulitis, septic prepatellar bursitis, and septic arthritis of the knee that does not respond to standard treatment. Treatment is identical to the treatment of osteomyelitis at other locations. The outcome is favorable in the child regarding range of motion and activity, although there may be persistent changes radiographically.