THE THREE TYPES OF ACUTE HAEMATOGENOUS OSTEOMYELITIS A Clinical and Vascular Study J. TRUETA, OXFORD, ENGLAND

It has been known for many years that acute haematogenous osteomyelitis varies in its clinical characteristics according to the age of the patient; thus osteomyelitis of the infant, child and adult constitute three separate clinical entities with few features in common apart from the generalised, or septicaemic, phase of the disease from which they all suffer. Fraser (1924), Paschlau (1932) and Green and Shannon (1936) were among the first to isolate the infantile type from that of the child and to describe its main characteristics during early life, including its high mortality-up to 45 per cent in the series of Green and Shannon. Since the inception of antibiotic treatment, Greengard (1946), Thomson and Lewis (1950) and Dennison (1955) have further contributed to the study of osteomyelitis in the newborn and have insisted on the existence of two forms, the severe and the mild. It must, nevertheless. be pointed out that the so-called mild type refers only to the mortality figures of this form of the disease, for even the milder form may cause severe and lasting damage to bone and joint in the infant. The separate nature of acute osteomyelitis in the adult has been recognised for many years. but the first full description of the condition in the adult was given only twenty-one years ago (Zadek 1938). In a systematic study of acute haematogenous osteomyelitis since 1944 we have treated 202 patients. This experience will be used here to summarise the main clinical features of these three types of osteomyelitis. I will begin by mentioning the main clinical features of the disease in childhood, which in osteomyelitis covers the span of life between one and sixteen years inclusively. This is followed by a summary of the disease in the infant and in the adult.