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Pediatric Humeral Osteomyelitis
Matthew Street1, Haemish Crawford
1*Department of Medicine, University of Auckland †Starship Children's Hospital, Auckland, New Zealand.
Insights
Pediatric humeral osteomyelitis, often caused by Staphylococcus aureus, requires prompt diagnosis and treatment, including antibiotics and surgery. Early recognition of concurrent septic arthritis is crucial for optimal outcomes.
Area of Science:
- Pediatric Orthopedics
- Infectious Diseases
- Musculoskeletal System
Background:
- Osteomyelitis is a frequent pediatric concern, with the humerus being the most commonly affected upper limb bone.
- Limited literature exists on pediatric humeral osteomyelitis, necessitating further research into its clinical course and treatment.
Purpose of the Study:
- To retrospectively review a large cohort of pediatric humeral osteomyelitis cases.
- To define the disease and clinical course to improve treatment strategies.
Main Methods:
- A 10-year retrospective review of pediatric humeral osteomyelitis cases from two major children's orthopedic departments.
- Utilized the Osteomyelitis Database to identify and analyze patient records from 1997-2008.
Main Results:
- Forty-nine patients were identified, with a mean age of 4.2 years; Maori and Pacific Islanders were overrepresented.
- Staphylococcus aureus was the most common pathogen; 53% of patients required surgery.
- Distal humerus involvement was frequent, and concurrent septic arthritis occurred in 7 cases, associated with higher inflammatory markers.
Conclusions:
- Humeral osteomyelitis diagnosis relies on clinical presentation and investigations, with awareness of potential septic arthritis.
- Prompt treatment with antibiotics and surgical intervention when indicated leads to good outcomes.
- Concurrent septic arthritis requires urgent management and is associated with limb non-use and elevated inflammatory markers.
Background:
Osteomyelitis is a common problem among the pediatric population. The humerus is the most commonly affected bone in the upper limb; however, there are relatively few series in the literature. This article retrospectively reviews a large number of cases of pediatric humeral osteomyelitis. We aim to further define the disease and its clinical course to aid in improved treatment.
Methods:
A 10-year retrospective review was performed of clinical records of pediatric humeral osteomyelitis at the 2 children's orthopaedic departments in the Auckland region. The Osteomyelitis Database was used to identify all cases between 1997 and 2007 at Starship Children's Hospital, and 1998 and 2008 at Middlemore's Kidz First Hospital.
Results:
Forty-nine patients were identified. Sixty-one percent were male with an average age of 4.2 years. Maori and Pacific Islanders were overrepresented. Seventy-eight percent were not using the limb, 70% complained of pain. Only 55% were febrile. White cell count, erythrocyte sedimentation rate, and C-reactive protein raised in 73%, 74%, and 79% of cases, respectively. X-ray, bone scintigraphy, and particularly magnetic resonance imaging were useful in radiologic diagnosis. Blood and tissue cultures revealed Staphylococcus aureus as the most common organism; there were 2 cases of community-acquired methicillin-resistant S. aureus. The distal humerus was more commonly affected. Fifty-three percent required surgery. Antibiotic therapy averaged 2.7 weeks intravenous and 2.6 weeks of oral therapy. There were 7 cases with adjacent septic arthritis, which had higher inflammatory markers. Major complications included 2 multiorgan failure and 1 growth disturbance.
Conclusions:
Humeral osteomyelitis can be diagnosed with an appropriate history, clinical examination, and investigations. One should be aware of concurrent septic arthritis and be prepared to treat this urgently. Those children with septic arthritis were not using the limb and had higher inflammatory markers. Treatment with intravenous and oral antibiotics and surgical debridement/washout if indicated can lead to good clinical outcomes with minimal complications.
Level Of Evidence:
Level IV-retrospective case series.
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