Deep, late infections associated with internal fixation in children

Area of Science:

• Pediatric Orthopedics
• Infectious Diseases
• Biomaterials Science

Background:

• Deep, late infections following internal fixation are documented in adults.
• Such infections have not been previously reported in pediatric populations.
• Cerebral palsy patients undergoing proximal femoral osteotomy are at risk.

Purpose of the Study:

• To report the first cases of deep, late infection in children after internal fixation of the proximal femur.
• To describe the clinical presentation, diagnosis, and management of these infections.
• To recommend guidelines for implant management in pediatric patients.

Main Methods:

• Retrospective case series of six pediatric patients.
• Analysis of clinical data, radiographic findings, and microbiological results.
• Review of treatment outcomes including debridement, hardware removal, and antibiotics.

Main Results:

• Infections occurred 7-24 months post-surgery in children with cerebral palsy.
• Common symptoms included hip pain and radiographic evidence of radiolucency around the lag screw.
• Staphylococcus aureus was the most frequent pathogen; treatment involved debridement, hardware removal, and antibiotics.

Conclusions:

• Deep, late infection is a potential complication of internal fixation in pediatric patients, particularly those with cerebral palsy.
• Routine removal of metallic implants after bony healing is strongly recommended to prevent such late infections.
• Early diagnosis and appropriate management are crucial for favorable outcomes.