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Hematogenous osteomyelitis of the wrist in children
Frank Fitoussi1, Estelle Litzelmann, Brice Ilharreborde
1Robert Debre Hospital, Paris, France. franck.fitoussi@rdb.aphp.fr
Insights
Wrist osteomyelitis is a severe childhood infection. High complication rates (33%) including growth disturbance (11%) highlight the need for prompt diagnosis and treatment to prevent long-term sequelae.
Area of Science:
- Pediatric Orthopedics
- Infectious Diseases
- Radiology
Background:
- Wrist osteomyelitis is a rare pediatric infection with limited published data on prognosis and treatment.
- Early diagnosis and intervention are crucial for managing this severe condition.
Purpose of the Study:
- To retrospectively analyze the clinical presentation, treatment, and outcomes of pediatric wrist osteomyelitis.
- To identify factors contributing to complications and long-term sequelae.
Main Methods:
- Retrospective review of 18 children diagnosed with wrist osteomyelitis (age > 4 months).
- Diagnosis confirmed by radiographic/bone scintigraphy, clinical picture, and elevated infection markers.
- Clinical and radiographic assessments at multiple follow-up intervals up to 2 years.
Main Results:
- Average delay to treatment was 7 days; 5 cases showed initial lytic bone lesions.
- Antibiotic treatment (Cefotaxim and Fosfomycin) for 6 weeks; 5 patients required surgical debridement for abscesses.
- Common pathogen: Staphylococcus aureus (MRSA in 1 case); 11% experienced growth disturbances (epiphysiodesis).
Conclusions:
- Wrist osteomyelitis presents with significant initial complications (33%), including abscesses and lytic lesions.
- Growth disturbances occurred in 11% of cases, indicating potential long-term orthopedic sequelae.
- Misdiagnosis at initial presentation may contribute to the high complication rate.
Introduction:
Wrist osteomyelitis is a rare infection, and few studies have been published about its prognosis and treatment.
Methods:
We retrospectively examined the medical records of 18 children older than 4 months who were diagnosed with wrist osteomyelitis. A definite diagnosis of wrist osteomyelitis required either confirmatory radiographic/bone scintigraphy changes associated with compatible clinical picture and elevated laboratory indices consistent with infection. The clinical evaluation was based on clinical and radiographic assessment at 1 week, 2 weeks, 3 months, 6 months, 1 year, and 2 years after the diagnosis.
Results:
Delay between initial symptoms and treatment ranged from 1 to 45 days (mean, 7 days). The radiographs at diagnosis demonstrated a lytic zone in the distal radial or ulnar metaphysis in 5 cases. All patients were treated with 6 weeks' course of antibiotics with sequential parenteral (7 days)-oral with a third-generation cephalosporin (Cefotaxim) associated with Fosfomycin. Surgical debridement was needed in 5 cases because plain radiographs, ultrasonography, or magnetic resonance imaging (MRI) had confirmed the presence of an intraosseous or subperiosteal abscess. Seven isolated organisms were methicillin-susceptible Staphylococcus aureus, and 1 was methicillin-resistant S. aureus. The average follow-up was 2 years. Significant orthopaedic sequelae as distal radius/ulna epiphysiodesis were apparent in 2 patients.
Discussion:
Wrist osteomyelitis is a severe infection with initial radiographic lytic zone in almost 30% of cases and with growth disturbance in 11% at the last follow-up. If we include the presence of intraosseous or subperiosteal abscess that required surgical debridement, the initial complication rate is 33%, which is superior to the 5% complication rate in the literature about general osteomyelitis. Misdiagnosis at initial clinical examination can explain this condition.
