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Osteomyelitis in burn patients requiring skeletal fixation
J P Barret1, M H Desai, D N Herndon
1Department of Surgery, Shriners Burns Hospital and The University of Texas Medical Branch, Galveston, TX, USA. j.p.barret.nerin@chir.azg.nl
Insights
Skeletal fixation is safe for severely burned children, with a low risk of infection. This treatment is recommended for exposed deep structures and positioning, though optimal pin removal timing requires further study.
Area of Science:
- Orthopedic Surgery
- Burn Care
- Pediatric Traumatology
Background:
- Severe burns frequently expose musculoskeletal structures, necessitating skeletal fixation.
- Osteosynthesis materials can increase infection risk, including osteomyelitis, in burn patients.
Purpose of the Study:
- To evaluate the safety and infectious complication rates of skeletal fixation in pediatric burn patients.
- To assess the association between complications like loose pins and osteomyelitis.
Main Methods:
- Retrospective review of pediatric patients with severe burns treated with pin insertion over 10 years.
- Analysis of 357 skeletal fixation procedures in 41 children with extensive full-thickness burns.
Main Results:
- A low incidence of infectious complications was observed: 3.6% loose pins, 4.8% pin site cellulitis, and 4.8% osteomyelitis.
- No significant association was found between loose pins, cellulitis, wound infection, or sepsis and the development of osteomyelitis.
Conclusions:
- Skeletal fixation is a safe procedure in severely burned pediatric patients, with a low rate of infectious complications.
- Consider skeletal fixation for managing exposed deep structures and for positioning in severe burn cases.
- Further research is needed to determine the optimal timing for pin removal in burn patients.
Abstract:
Deep and severe burns often present with the exposure of musculoskeletal structures and severe deformities. Skeletal fixation, suspension and/or traction are part of their comprehensive treatment. Several factors put burn patients at risk for osteomyelitis, osteosynthesis material being one of them. In order to determine the safety of skeletal fixation, we reviewed all pediatric patients treated with pin insertion during the past 10 years. Forty-one severely burned children (61+/-3% TBSA full thickness burns), had a total of 357 skeletal fixation procedures. Pins were maintained an average of 25.3+/-1.7 days. Thirteen pins (3. 6%) were loose before the expected time of removal, two patients (4. 8%) presented with cellulitis of the pin site and two patients (4. 8%) presented with osteomyelitis. Loose pins, pin site cellulitis, burn wound infection and sepsis were not associated with osteomyelitis. Skeletal fixation in severely burned patients presents with a low incidence of infectious complications. Its use should be considered in patients affected by severe burns that present with exposed deep structures and for positioning purposes. The exact timing for pin removal in burned patients is still to be defined.