Primary Fibular Osteomyelitis in Children: A Systematic Review.

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.