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Background: Acute haematogenous osteomyelitis (AHO) of the long bones is frequently complicated by the development of sequestrum, pathological fracture, chronic osteomyelitis and growth arrest. We aimed to determine the frequency of complications and outcomes of patients with AHO of the long bones requiring surgical evacuation of pus. We furthermore examined the predictive value of clinical, biochemical and radiological variables on the development of complications following AHO. Methods: Eighty-one patients were included. Clinical course, occurrence of complications and eventual outcome were documented. Complications were defined as: development of sequestrum, chronic osteomyelitis, pathological fracture and/or growth arrest. Results were analysed to determine factors predisposing to complications, and the difference in outcome between patients that developed complications and those that did not. Results: The mean age at presentation was 7.5 years, and the mean follow-up was 1.8 years. Thirty-nine patients (48%) developed 67 complications. Twenty-six patients developed sequestrum, 19 pathological fractures, 13 chronic osteomyelitis and nine growth arrest. No presenting feature was associated with an increased risk of developing complications. The percentage of cortex with radiological changes at 6 weeks (66.1% vs 44.9%, p<0.0001) was associated with the development of complications. Duration of admission was significantly longer for those patients that developed complications (21 weeks vs 6 weeks; p<0.001) Thirteen patients that developed complications had a poor outcome, compared to 0 patients that did not (p<0.001). Conclusion: AHO may result in severe disability, despite early recognition and adequate treatment. Early recognition of extensive bony involvement warrants increased vigilance to identify and manage complications timeously. Level of evidence: Level 4

Complications following acute severe haematogenous osteomyelitis of the long bones in children