Chronic osteomyelitis at Tikur Anbessa hospital, Addis Ababa University, Ethiopia.

Abstract

Background: Chronic osteomyelitis (COM) is a severe, persistent and sometimes incapacitating infection of bone and bone marrow. This prospective study at Addis Ababa University, Medical Faculty, Department of Orthopaedic Surgery, Tikur Anbessa Hospital was aimed at determining the pattern of chronic osteomyelitis and the out come of its management.

Patients and Methods: Using a standardized questionnaire, 442 consecutive patients with chronic osteomyelitis presenting to the department in the study period were interviewed. Operated patients were followed up separately. Diabetic and vascular foot-osteomyelitis patients were excluded.

Result: There were 336 (76%) males accounting for 76%. The mean age at the initial presentation was 18 years The youngest patient was aged one month and the oldest was 84 years.. The majority (68%) of patients came from rural areas. Discharging sinus was the commonest clinical presentation observed in 93%. Squamous cell carcinoma was present in four patients. The disease followed trauma in 27%. Tuberculosis osteotitis was proven in three of the suspected patients. Compound fracture accounted for 93 (79%) of the post traumatic onset. More than half (52%) of the patients had visited bone setters in the course of their illness. The commonest anatomical type noticed using Cierny- Mader’s classification was type III (273, 63%) followed by type IV (82, 19%). Lower limb bones were the commonest affected. Nine of the patients had multiple bones affected and three of these patients agreed to HIV screening were all positive. Swab culture was done in only half of the patients. The main isolate was Staph. Aureus and most of the organisms were resistant to the common antibiotics. Sequestrectomy had been done only in 73 (16.5%) of the patients.

Conclusion: Osteomyelitis is a common, persistent and serious problem, and attention should be given to the preventable forms. There should be a proper system of referral for compound fractures or
there should be more orthopaedic beds to avoid such referrals. Training bone setters may help reduce chronic osteomyelitis. Sequestrectomy alone is not sufficient to treat chronic osteomyelitis.