Acute hematogenous osteomyelitis of the neck of the femur in children treated with drilling

We re-examined 11 children (mean age 6.5 years) who had been treated with surgical drilling and intravenous (i.v.) antibiotics in high doses for acute hematogenous osteomyelitis of the neck of the femur. The mean follow-up time was 3.9 (2.9-6.4) years. 9 children who had been treated with early surgical drilling and i.v. antibiotics were all symptom-free and had normal radiographs at follow-up. The other 2 children had radiographic changes (metaphyseal rarefaction) already when referred to us. They had been treated with antibiotics alone before referral until the infection had spread to the hip joint. At follow-up, the clinical and radiographical findings were abnormal, I had a severely deformed hip. In our opinion, treatment with i.v. antibiotics alone may not prevent extension of the infectious process to the hip joint in some cases, even when the medication is given in high doses. Therefore, we believe that the addition of early surgical drilling is justified to prevent this feared complication.