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Chronic osteomyelitis in children: treatment by intramedullary reaming and antibiotic-impregnated cement rods
Elhanan Bar-On1, Daniel M Weigl, Noam Bor
1Pediatric Orthopaedic Unit, Schneider Children's Medical Center, Petah Tikva, Israel. elbar@013.net
Insights
This study shows that combining surgical debridement with local and systemic antibiotics effectively treats chronic osteomyelitis (CO) in children. The innovative approach led to full recovery in all patients, eradicating infection and preserving function.
Area of Science:
- Pediatric Orthopaedics
- Infectious Diseases
- Surgical Innovation
Background:
- Chronic osteomyelitis (CO) is a rare but challenging condition in children.
- Effective treatment requires aggressive surgical intervention and prolonged antibiotic therapy.
Purpose of the Study:
- To evaluate a novel treatment combining surgical debridement, intramedullary antibiotic-impregnated rods, and systemic antibiotics for pediatric CO.
- To assess the safety and efficacy of this combined therapeutic approach.
Main Methods:
- Retrospective review of four pediatric patients with CO treated between 2005-2006.
- Surgical protocol included debridement, lavage, intramedullary canal reaming, and insertion of gentamicin-impregnated polymethylmethacrylate (PMMA) rods and beads.
- Systemic antibiotic therapy (cephalothin) followed by oral antibiotics based on sensitivity.
Main Results:
- All four patients achieved full recovery with no signs of infection at a mean follow-up of 41 months.
- Treatment duration averaged 8 months, with antibiotic courses lasting up to 37 weeks.
- One patient required additional surgery for a fracture, but all regained full function.
Conclusions:
- The combined approach of reaming, lavage, and local/systemic antibiotics is safe and effective for pediatric CO.
- This method successfully eradicates infection and prevents further tissue damage.
- The treatment strategy offers a promising solution for this difficult-to-treat condition.
Background:
Chronic osteomyelitis (CO) is rarely encountered in developed countries and is especially rare in children and adolescents. However, on occurrence, it can pose a difficult therapeutic challenge necessitating a combination of aggressive surgical treatment and prolonged antibiotic administration.
Methods:
Four patients were treated for CO in the Pediatric Orthopaedic Unit at Schneider Children's Medical Center between June 2005 and December 2006 and were reviewed retrospectively. Surgical treatment consisted of debridement and lavage, reaming of the intramedullary canal and insertion of gentamycin-impregnated polymetamethacrylate rods into the canal and beads around the infection site. At rod removal reaming and lavage were repeated. Antibiotic treatment was initiated with intravenous cephalothin, followed by prolonged oral treatment according to bacterial sensitivity.
Results:
Cement rods and beads were removed 16 to 62 days after insertion. Intravenous antibiotics were continued for 6 weeks (3-13) and total antibiotic treatment length was 16 weeks (10-37). Total treatment time from presentation to full resolution averaged 8 months (2-18). One patient sustained a fracture requiring osteotomy and correction. At mean follow-up of 41 months from rod removal (36-46), all patients are asymptomatic and fully functional with no clinical signs of infection. C-reactive protein is within normal limits in all 4 patients.
Conclusions:
The method presented combining reaming, lavage and local and systemic antibiotic treatment was found to be safe and effective in the treatment of CO, eradicating the infection and preventing further tissue loss.
Level Of Evidence:
Therapeutic study, clinical case series: level IV.
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