Acute haematogenous osteomyelitis with special reference to osteitis of the neck of the femur.

Acute haematogenous osteomyelitis is still a common disease in Cape Town. During the past eight years we have treated 331 cases (351 bones) in the University of Cape Town teaching hospitals; 85% of these were children of 12 years and under, the disease accounting for 3-3% of the admissions to our Children's hospital where we have set aside a special ward for patients suffering from osteomyelitis. Not only is the disease common but it seems to be increasing in frequency and in severity. Thus there has been a steady increase in the annual admissions (Fig. 1) and, whereas in 1949 only 24% of our cases were regarded as severe (Du Plessis, 1953), in 1959 the proportion had increased to 57% (Shandling, 1960). Our cases have recently been reviewed by one of us (Shandling, 1960), and our findings in regard to age and sex incidence, social status, pre-existing septic foci and predisposing trauma are in keeping with those of others (Altemeier and Helmsworth, 1945; Agerholm and Trueta, 1946; Caldwell and Wickstrom, 1950; White and Dennison, 1952; Dennison, 1952; Trueta and Morgan, 1954). The bones most commonly affected were upper tibiae, lower femora and tibiae and upper femoral shafts (Fig. 2). In this paper we wish to discuss osteomyelitis of the neck of the femur of which we have had 27 cases (28 bones) since 1952. Before doing so, a consideration of the racial incidence of osteomyelitis may be of interest.