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Pediatric Tibial Osteomyelitis
Brad Stone1, Matthew Street, Warren Leigh
1*Department of Orthopaedics, Auckland City Hospital, Grafton†Department of Orthopaedics, Middlemore Kids First Hospital, Papatoetoe‡Department of Orthopaedics, Starship Childrens' Hospital, Grafton, Auckland, New Zealand.
Insights
Pediatric tibial osteomyelitis often presents with significant symptoms and requires prolonged treatment, including antibiotics and surgery. Staphylococcus aureus is the most common pathogen, and while outcomes are generally good, complications like relapse can occur.
Area of Science:
- Orthopedics
- Pediatric Infectious Diseases
- Medical Microbiology
Background:
- Osteomyelitis frequently affects the tibia in children, leading to significant complications.
- Early diagnosis and effective management are crucial for favorable outcomes.
Purpose of the Study:
- To retrospectively review pediatric tibial osteomyelitis cases.
- To compare findings with existing literature to identify factors improving diagnosis and treatment outcomes.
Main Methods:
- A 10-year retrospective review of pediatric tibial osteomyelitis cases from two Auckland children's hospitals.
- Inclusion criteria involved reviewing clinical records and investigations for 191 patients.
Main Results:
- The average symptom duration was 5.7 days; 60% of patients had impaired weight-bearing.
- Elevated inflammatory markers (ESR, CRP) were common; Staphylococcus aureus was the most frequent pathogen.
- 43% of patients underwent surgery, with an average treatment course of IV and oral antibiotics; complications and readmissions were noted.
Conclusions:
- Pediatric tibial osteomyelitis diagnosis may necessitate advanced imaging and extended treatment.
- Intravenous and oral antibiotics, with surgical debridement when needed, generally lead to good outcomes, despite potential complications.
Background:
Osteomyelitis shows a strong predilection for the tibia in the pediatric population and is a significant source of complications. The purpose of this article is to retrospectively review a large series of pediatric patients with tibial osteomyelitis. We compare our experience with that in the literature to determine any factors that may aid diagnosis and/or improve treatment outcomes.
Methods:
A 10-year retrospective review was performed of clinical records of all cases of pediatric tibial osteomyelitis managed 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 Kids First Hospital.
Results:
One hundred ninety-one patients fulfilled the inclusion criteria, and had a review of clinical notes and relevant investigations. The average duration of symptoms before presentation to hospital was 5.7 days. Less than 40% of patients had a recent episode of trauma. Almost 60% of patients could not bear weight on admission. Over 40% of patients had a temperature above 38°C. Erythrocyte sedimentation rate was elevated in 78% and the C-reactive protein was elevated in 90% of patients. In total, 42% of blood cultures and almost 75% of tissue cultures were positive, with Staphylococcus aureus being the most commonly cultured organism. X-rays, bone scans, and magnetic resonance imaging were all used to aid the diagnosis. About 43% of patients had surgery. Treatment length was an average of 2 weeks 6 days of intravenous antibiotics followed by 3 weeks 2 days of oral treatment. Six postsurgical complications and 46 readmissions were noted: 25 for relapse, with the remainder due to social and antibiotic-associated complications.
Conclusions:
Although generally diagnosed on presentation, pediatric tibial osteomyelitis can require more sophisticated investigations and prolonged management. Treatment with intravenous and oral antibiotics and surgical debridement where indicated can lead to a good clinical outcome, although complications are often noted.
Level Of Evidence:
Level IV-Prognostic study.
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