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Deep, late infections associated with internal fixation in children
Insights
Deep, late infections after internal fixation surgery are rare in children. This study highlights six cases in children with cerebral palsy, emphasizing the need for prompt implant removal post-healing.
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.
Abstract:
Deep, late infection associated with internal fixation is well known in adults, but has not been previously reported in children. We report here six cases of deep, late infection in children associated with internal fixation of the proximal femur. All patients had cerebral palsy and had undergone a proximal femoral osteotomy for hip subluxation or dislocation. The patients presented with infection between 7 and 24 months after a period of total recovery. The clinical presentation was variable, although many patients had increasing hip pain. Radiographs showed radiolucency around the lag screw. The bacteriologic finding was usually Staphylococcus aureus, and patients responded to wound debridement, hardware removal, and intravenous antibiotics. In light of these cases of deep, late infection, we strongly urge routine removal of metallic implants as soon as bony healing will allow.