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Surgical treatment of chronic osteomyelitis in children admitted from developing countries
1Department of Trauma, Hand and Reconstructive Surgery, Verbundkrankenhaus Bernkastel-Wittlich, Wittlich, Germany.
Insights
Surgical management of pediatric chronic osteomyelitis in developing nations is complex. Effective treatment requires radical bone debridement and plastic surgery for tissue reconstruction, leading to successful outcomes.
Area of Science:
- Pediatric Orthopedics
- Infectious Diseases
- Surgical Management
Background:
- Chronic osteomyelitis in children presents significant challenges in developing countries.
- This study aimed to analyze disease extent and therapeutic strategies.
Purpose of the Study:
- To evaluate the surgical management of chronic osteomyelitis in pediatric patients from developing countries.
- To report on disease characteristics, treatment interventions, and outcomes.
Main Methods:
- A retrospective study of 27 children treated for chronic osteomyelitis between 2009 and 2013.
- Data collected included disease localization, duration, microbial spectrum, surgical procedures, and hospital stay.
Main Results:
- The mean disease duration was 18 months, with an average of 3 prior surgeries.
- Tibia and femur were most commonly affected; Staphylococcus aureus was the primary pathogen (75%).
- An average of 4 surgical procedures were required, including bone stabilization, soft tissue reconstruction, and bone transfers in select cases.
Conclusions:
- Radical osseous debridement is crucial for surgical treatment of pediatric chronic osteomyelitis.
- Plastic-surgical expertise is essential for reconstructing bone and soft tissue defects.
- The study highlights the need for comprehensive surgical approaches in managing this condition.
Background:
The surgical management of chronic osteomyelitis in children is still challenging in developing countries. This study analysed the extent of the disease and the therapeutic regime.
Subjects And Methods:
This was a retrospective study in two primary health care hospitals from January 2009 to December 2013, 27 children (20 males and 7 females, mean age 7 years) admitted from developing countries who were treated for chronic osteomyelitis. Localization, duration of the disease, extent of the osseous involvement, spectrum of germs, number of previous and required surgical procedures and duration of hospital stay are reported.
Results:
A total of 16 cases had haematogenous and 11 cases post-traumatic aetiology. The mean duration of the disease was 18 months. On average, three (range, 1-12) previous surgical procedures were performed. The affected bones were: Tibia in 11, femur in 8, forearm in 6 cases, spine and humerus each in 1 case. Staphylococcus aureus was the responsible germ in 75%. On average, four (range, 2-8) surgical procedures were required. Osseous stabilizations were necessary in 17, plastic soft tissue reconstructions in 8 cases. In three cases with metaphyseal/diaphyseal defect, bone transfers had to be performed (2 × fibula-pro-tibia, 1 × rib for radius). The mean hospital stay took 8 (range, 4-20) weeks. Three local recurrences occurred within 3 months, all could be cured surgically.
Conclusions:
The surgical treatment of chronic osteomyelitis in children requires a radical osseous debridement. The knowledge of different plastic-surgical procedures is necessary to reconstruct osseous and/or soft tissue defects.
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