Primary Fibular Osteomyelitis in Children: A Systematic Review
Nia Nikkhahmanesh1, Neeraj Vij1, Ashish S Ranade2
1Orthopedics, University of Arizona College of Medicine, Phoenix, USA.
Insights
This systematic review details pediatric fibula osteomyelitis, finding fever, antalgic gait, and localized tenderness are key symptoms. Staphylococcus aureus is the most common pathogen, and surgery is frequently successful with few complications.
Area of Science:
- Pediatric Orthopedics
- Infectious Diseases
- Systematic Review and Meta-Analysis
Background:
- Osteomyelitis of the fibula is a rare condition in children, with limited published data.
- Existing literature primarily consists of case series, lacking comprehensive disease descriptions.
- A thorough understanding of pediatric fibula osteomyelitis is needed for improved diagnosis and treatment.
Purpose of the Study:
- To provide the first comprehensive summary of pediatric fibula osteomyelitis.
- To analyze demographics, symptoms, laboratory values, microbiology, and treatment outcomes.
- To synthesize existing literature for a clearer picture of this rare condition.
Main Methods:
- Systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) guidelines.
- Searched three databases, screening 239 studies and performing full-text review on 26.
- Quantitative analysis of 12 articles, with descriptive summarization due to data heterogeneity; quality assessed using Newcastle-Ottawa scale.
Main Results:
- The study included 21 pediatric cases (average age 7.71 years, 57% male).
- Common symptoms included fever (86%), antalgic gait (57%), and localized tenderness (81%), with distal fibula involvement (90%).
- Staphylococcus aureus (48%) was the most common pathogen; 81% underwent surgery with no reported complications.
Conclusions:
- Fever, antalgic gait, and localized tenderness are critical indicators for suspecting fibula osteomyelitis in children.
- Prompt laboratory and radiographic evaluation are essential for timely diagnosis and better outcomes.
- Surgical intervention is often necessary, demonstrating a low complication rate; improved microbiologic diagnosis can refine antibiotic selection.
Abstract:
Osteomyelitis of the fibula is rare and is especially rare in children. The published literature is limited to case series and is thus lacking a comprehensive description of the disease. The purpose of this systematic review is to provide the first comprehensive summary of the demographics, presenting symptoms, laboratory values, microbiology, and treatment results of osteomyelitis of the fibula in children based on the existing literature. This institutional review board (IRB)-exempt systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) guidelines. Three search engines were used for a total of 239 studies. Twenty-six studies were screened by full text. Twelve articles underwent a quantitative analysis. Due to limited data and heterogenous reporting, the data were summarized descriptively. The methodologic quality of the studies was evaluated based on the Newcastle-Ottawa scale. The average age was 7.71±3.49 years, and males comprised 57% of the 21 cases. The most common presenting symptoms were fever (86%), antalgic gait (57%), and localized tenderness (81%). The most common site of involvement was the distal third of the fibula (90%). The average C-reactive protein (CRP) was 90.1±38.3 mg/L, and the average erythrocyte sedimentation rate (ESR) was 58.8±21.2 mm/hour. Staphylococcus aureus was the most cultured pathogen reported in 10/21 cases (48%). Open surgery was performed in 17/21 cases (81%), and there were no reported complications. Fever, antalgic gait, and localized tenderness should raise the index of suspicion. Prompt laboratory and radiographic evaluations can help reduce delays in diagnosis and improve outcomes. Blood and tissue cultures are currently performed in about half of the cases. Improvement in our microbiologic diagnosis has the potential to improve antibiotic selection. Local methicillin-resistant Staphylococcus aureus (MRSA) prevalence must be taken into consideration when starting empiric antibiotic treatment. Surgical treatment is often required with a low complication rate. The clinical and laboratory parameters identified in this study have the potential for integration into a composite clinical score.
