Osteomyelitis of flat bones: A report of 20 cases and review of the literature

Objective: Osteomyelitis is frequently localized on the fertile metaphysis of long bones. However, there are other locations such as short or flat bones. The aim of our study was to determine the diagnostic, therapeutic and evolutionary aspects of osteomyelitis of flat bones in our environment.

Methods: It's was a retrospective study conducted from January 2013 to December 2017; Children from 0 to 16 years admitted for osteomyelitis of a flat bone where included.

Results: We followed 19 patients who presented 20 locations of osteomyelitis on a flat bone. They accounted for 9.1% of all osteomyelitis observed during the study period. The average age was 6.7 years (9 months-14 years). The clinical picture most often associated with fever and local inflammatory swelling related to an abscess. The predominant locations were the sternum with 8 cases and the scapula with 4 cases. Eleven patients were homozygous sickle cell patients. The diagnosis was strengthened with standard radiography in the majority of cases. A micro-organism was isolated in 8 cases (40%) and Staphylococcus aureus was the predominant germ in 7 cases. Nearly all patients were treated with surgical drainage of the abscess, bone curettage and antibiotics. A typical radiographical evolution has been observed with bone reconstruction in 15 cases with a mean follow-up of 3.3 years.

Conclusion: Flat bones are relatively rare locations of osteomyelitis. Standard radiography remains the first-line examination. Their treatment obeys the same rules as that of osteomyelitis of long bones. There is a successful outcome when the care is early and adequate.