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Clinical features and sequelae of pediatric osteomyelitis following surgical treatment: a 10-year retrospective study
Hongri Wu1,2, Shulin Wang2, Jie Shen2
1Department of Orthopaedics, Navy 905th Hospital, Navy Medical University, Shanghai, 200050, People's Republic of China.
Insights
Surgical treatment for pediatric osteomyelitis (OM) can lead to sequelae, with traumatic and chronic infections posing higher risks. Early intervention and awareness of risk factors are crucial for managing this severe bone infection in children.
Area of Science:
- Pediatric Infectious Diseases
- Orthopedic Surgery
- Clinical Outcomes Research
Background:
- Osteomyelitis (OM) in children is a serious infection with potential long-term complications.
- Surgical intervention is often necessary for pediatric OM management.
- Understanding sequelae and their risk factors is vital for improving patient outcomes.
Purpose of the Study:
- To analyze the clinical features of pediatric osteomyelitis patients undergoing surgery.
- To identify and evaluate the sequelae following surgical treatment for pediatric OM.
- To determine risk factors associated with the development of sequelae in this population.
Main Methods:
- Retrospective review of pediatric OM patients treated surgically from 2013-2023.
- Minimum 1-year follow-up to assess clinical outcomes and sequelae.
- Logistic regression analysis to identify risk factors for sequelae.
Main Results:
- 220 pediatric patients included; 68.6% male, mean age 11.69 years.
- Hematogenous infection was most common (56.8%), with 67.7% having chronic infections (>3 months).
- 16.8% experienced sequelae (growth arrest, joint injury, deformities); risk factors included external fixators, traumatic/chronic infection, and multiple debridements.
Conclusions:
- Surgical treatment for pediatric OM, especially traumatic and chronic cases, can be effective but carries risks of sequelae.
- While infection cure is often achievable, clinicians must monitor for and mitigate potential long-term complications.
- Identifying risk factors like infection type and treatment approach aids in managing pediatric osteomyelitis outcomes.
Aim:
Osteomyelitis (OM) in children is a severe infectious disease, and its sequelae are common. The purpose of this study was to analyze the clinical features and sequelae of pediatric patients following surgical treatment.
Patients And Methods:
We reviewed all pediatric patients with OM at our clinical center who underwent surgical debridement and antimicrobial therapy from January 2013 to December 2023. Patients were followed for at least 1 year to evaluate clinical outcomes and the occurrence of sequelae. Risk factors associated with sequelae were analyzed via Logistic regression.
Results:
A total of 220 pediatric patients with a mean age of 11.69 ± 3.79 years were included. Of these, 151 (68.6%) were male. The majority were due to hematogenous infection (56.8%), while a significant proportion of patients had chronic infections with 149 (67.7%) had more than three month infection duration. The most frequently involved bones were the tibia (44.5%) and femur (29.5%). In addition, 103 patients (46.8%) had a detected pathogen, with Staphylococcus aureus (34.1%) being the most common, followed by Pseudomonas aeruginosa (4.1%) and Staphylococcus epidermidis (3.2%). After a median follow-up of 2 years (range: 1-6 years), 8 patients (3.6%) had infection recurrence; However, they were completely cured after revision surgery. A total of 37 patients (16.8%) reported sequelae, including growth arrest (n = 21), joint injury (n = 16), limb deformities (n = 7), chronic pain (n = 3), and pathologic fractures (n = 2). Regression analysis showed that the use of an external fixator (OR = 8.85, p = 0.001), traumatic infection (OR = 9.88, p = 0.002), prolonged infection duration (≥ 3 months) (OR = 8.00, p = 0.007), and multiple debridements (n ≥ 2) (OR = 5.49, p = 0.021) were risk factors for sequelae, after adjusting for the age and infection site of patients.
Conclusion:
The data indicated that a significant proportion of children with traumatic and chronic OM suffered surgical intervention, although hematogenous infections remain the predominant type. Meanwhile, the infection cure was often achievable. However, clinicians should still be aware of the potential sequelae and related risk factors following surgical treatment.
