Nonspinal tuberculous osteomyelitis in children

Tuberculous osteomyelitis is uncommon in children but its incidence seems to have increased in our hospital recently. From April 1984 to December 1994, we treated 12 children with this problem. Three cases were diagnosed in the first 7 years and nine cases in the latter 4 years. Primary spinal lesion was excluded. There were seven boys and five girls, with an average age of 2.4 years (range 1-4.5). Anatomic sites of involvement were distal femur in three patients, proximal tibia in three, foot in three, proximal femur in one, proximal humerus in one, proximal radius in one, distal radius in one, and rib in one. Except for one case of hip lesion, the most common symptom was localized swelling. Delay in diagnosis was 6.6 months on average. The diagnosis was confirmed bacteriologically or histologically in all patients after surgical debridement and curettage. Anti-tuberculosis (TB) drugs were administered for 6 months postoperatively. All patients were followed-up for an average of 3.8 years (range 2-8) with satisfactory healing of their tuberculous lesions. Two cases were complicated with physeal bar formation. One patient had residual flexion contracture of the knee. Although the mortality from TB has decreased in Taiwan, the frequently reported late cases of TB deserve attention. Physicians should be aware that TB remains an important cause of bone lesions. These lesions can be healed by combined therapy with surgical debridement and anti-TB medication for 6 months.