Chronic osteomyelitis in Sub-Saharan Africa—A Review

Abstract

Background: Chronic osteomyelitis (COM) has remained an orthopaedic clinical challenge for many decades. It poses a socio-economic burden to patients and the health care system. We conducted this study to understand the epidemiological and clinical features of COM in Sub-Saharan Africa (SSA). Methods: A database-based search was done through PubMed, Google Scholar and Bioline for articles focusing on the epidemiology and clinical features of COM in SSA. Thirty-three articles were considered in the study based on the standards of assessing the level of evidence. Analysis and synthesis of the articles were conducted. Results: The incidence of COM in SSA is far greater than high income countries. Tibia is the commonly affected bone with more than 30% of cases, while the peak age is between the interval 10-21 years of age. Sickle cell disease, peripheral vascular disease, diabetes mellitus, Buluri ulcers and septicemia were reported as potential risk factors in SSA. 5093% of patients present with sinus drainage whereas Staphylococcus Aureus is the causative agent in 60-80% of the cases. Standard radiography and CT scan remain useful diagnostic tools in this region. The curative therapy involves radical surgical infection control with adjunct reconstructive procedures and antibiotherapy. Conclusion: COM remains on the rise in SSA. This trend is in line with the rise in exogenous osteomyelitis, road traffic injuries in addition to factors like patient characteristics, ignorance and poverty. Adolescents are more affected where immunosuppressive and vaso-occlusive disorders are main risk factors. We recommend extension of research on COM to overcome scarcity of data seen.