Osteomyelitis among children

Skeletal and Surgical Evidence for Acute Osteomyelitis in Non‐Adult Individuals

“…The data on AO cases in children at CUH are consistent with the reported information offered by physicians at that time. The documentary evidence shows that 65% of the individuals affected were aged between 8 and 15 years, which concurs with the ages reported in the pre‐antibiotic series studied (Amberg & Ghormley, ) and in current epidemiological surveys (Gutierrez, ). The proportion of boys to girls non‐adults displaying pathologies could provide information about their susceptibility to disease and cultural views on gender (Lewis, ).…”

“…The proportion of boys to girls non‐adults displaying pathologies could provide information about their susceptibility to disease and cultural views on gender (Lewis, ). Between 1923 and 1929, the cases of AO reported in the CUH surgical statistics were more frequent in boys than in girls (2:1), a proportion similar to that found in other studies (Farr, ; Amberg & Ghormley, ), whereas Ortner () referred to a ratio of at least 3:1.…”

“…Nowadays, although mortality due to AO is close to zero in many countries, different frequencies are observed by patient series (Gutierrez, ). The mortality at the CUH between 1923 and 1929 was relatively high (23.3%), when compared with frequencies ranging from 5% (Amberg & Ghormley, ) to 25% (Shandling, ), which indicated that mortality depends on the age of the patient, the stage of infection, and the treatment employed. Unfortunately, information about the specific cause of death of the patients studied here was not found; consequently, it is not known whether they died due to surgery, which was mainly drastic and immediate, or due to the advanced state of infection, or more probably, a combination of both.…”

“…Before the development of antibiotics, surgery was considered the best therapy for AO by some surgeons in Portugal as elsewhere, whereas others advocated for more conservative management (Holman, ; D'Abreu, ). Factors such as the severity of the diagnosis and the age of the patient were also considered before surgery was chosen (Amberg & Ghormley, ; Pimenta, ). According to Pimenta (), for many years, bone trepanation, for facilitation of pus drainage, was the method of choice to treat AO.…”

“…Consequently, identifying the presence or type of osteomyelitis in palaeopathological cases is challenging (Aufderheide & Rodríguez‐Martín, ; Ortner, ). Indeed, although a high mortality (above 20%) due to haematogenous AO is reported in the pre‐antibiotic clinical literature (Bancroft, ; Amberg & Ghormley, ), only a small number of non‐adult skeletons have been diagnosed with osteomyelitis in the archaeological record (see for example Ortner, ; Lewis, ).…”