These findings suggest that perhaps the answer to the problem is not the earliest possible surgical invasion of the bone, but a well-timed adequate drainage of the medullary canal when the individual's resistance is at the highest possible point.
It has been our repeated experience that an acutely suffering child, who enters the wards in a badly dehydrated condition with a very high temperature and pulse rate, will become a vastly better operative risk in twenty-four, forty-eight, or even seventy-two hours, during which the suffering has been relieved and the dehydration overcome. The improvement in the general condition will be obvious and the chart will confirm this impression. The lesion will probably be quite evident when the child enters the hospital, as will the eventual necessity for an operative procedure, but timing is the important factor in treating acutely sick children. A blood-borne infection of bone may be more successfully handled by adhering to the principle of allowing the infection to localize. A catastrophe may result from a too early ostectomy of an infected bone, for the same reason that incision of a brawny cellulitis is often fatal.
On the other hand, it seems unwise negligently to permit an individual to harbor a well-formed abscess for days, or to drain such an abscess only partially and imperfectly. Such procedures are favorable to the formation of multiple metastatic lesions, as is evidenced by the preponderance of these lesions in cases where only incision of the soft tissues was carried out, or those in which spontaneous rupture of the abscesses was permitted.
(C) 1936 All Rights Reserved.The Journal of Bone and Joint Surgery, Inc.