Nous rapportons une série de 28 cas d'ostéomyélite du col du fémur afin de mettre en évidence les particularités cliniques et paracliniques de cette localisation. Le tableau clinique non spécifique était fait d'un syndrome douloureux de la hanche dans un contexte fébrile. Le diagnostic de l'ostéomyélite du col du fémur a été réalisé en se basant, sur l'imagerie (IRM et scintigraphie) dans trois cas avec une preuve bactériologique dans deux cas, sur les constatations opératoires qui ont confirmé l'atteinte du col dans 19 cas et sur les modifications de l'aspect radiologique du col dans six cas. Le traitement a été médical dans tous les cas, 25 malades ont du subir un acte chirurgical. On a noté cinq complications thromboemboliques et cinq cas d'évolution vers une pandiaphysite fémorale. Nos résultats ont été analysés avec un recul moyen de trois ans et demi. Sur le plan fonctionnel, la mobilité de la hanche était complète dans 78 % des cas. On a observé quatre cas de raideur de la hanche et deux cas d'ankylose. Sur le plan anatomique, on a noté deux cas de nécrose céphalique partielle et deux cas de nécrose totale de la tête et du col. L'analyse de nos résultats a montré que le pronostic de l'ostéomyélite du col du fémur est fonction du délai de prise en charge. Les malades traités tardivement présentent des mauvais résultats. L'évolution vers une pandiaphysite est un facteur péjoratif.

Osteomyelitis of the neck of the femur is uncommon, often with a misleading clinical presentation. We report a series of 28 cases of osteomyelitis of the femoral neck to illustrate the particular clinical and imaging findings related to this localization.

This was a series of 28 children treated in our unit from 1990 through 2004: 17 boys and 11 girls, mean age eight years (range one month to 14 years). We analyzed the data in this series using a standard checklist, which noted the diagnostic and therapeutic measures. Results were analyzed by studying the complications, anatomic and functional outcome at mean follow-up of 3.5 years.

Time from symptom onset to consultation was five days on average with a delay of 4.5 days from consultation to hospitalization. Intense pain was noted for eight patients (28%) and total functional incapacity of the limb was noted for 15 (53%). Hip stiffness was observed in 11 patients (39%). The diagnosis of osteomyelitis of the femoral neck was established on the basis of imaging (MRI or scintigraphy) in three patients with bacteriological proof in two, of operative findings which confirmed the neck localization in 19, and on changes in the X-ray image of the neck in six. A positive bacteriology was noted in 71%. The germ was isolated from blood cultures and local samples obtained by arthrotomy in five patients (same germ), only in blood cultures for four, and only in local samples in 11. Met-S Staphylococcus aureus was isolated in 18 patients, Met-R S. aureus in one and a Streptococcus in one. All patients were given medical treatment and 25 underwent surgery. There were five thromboembolic complications and five patients who developed femoral pandiaphysitis. Results were analyzed at mean 3.5 years (range four months to 14 years). Complete hip motion was recovered in 78%. There were four cases of hip stiffness and two cases of ankylosis. Partial cephalic necrosis was noted in two hips and total necrosis of the head and neck in two.

Little data is available in the literature on isolated osteomyelitis of the femoral neck. Based on the pathogenic mechanisms known for osteomyelitis, an isolated localization in the neck of the femur, with no other site in the hip joint, is quite possible in an early stage of infection. We discuss the specific clinical and imaging features of this localization. Analysis of our findings show that the prognosis of femoral neck osteomyelitis is directly related to time to management. Outcome is poorer when treatment is started late. Prognosis is poor if pandiaphysitis develops.