Osteomyeltis is also extremely common. This is sometimes associated with a staphylococcal septicaemia but commonly occurs in patients with sickle cell
disease due to salmonella infection. This was a 12-month-old Ghanian child who developed inability to walk and some swelling of the limbs. She had sickle cell disease. In Ghana children learn to walk at an early age. X-rays showed extensive osteomyelitis involving both lower legs, femora, radii, ulnae and humeri. The appearance in the upper limbs was less marked than that in the lower limbs where there were several pathological fractures.