Pseudomonas osteochondritis complicating puncture wounds in children

Pseudomonas osteochondritis is an uncommon complication of puncture wounds. It can have a particularly devastating affect in the growing child, often resulting in significant permanent sequelae. To assess the current approach to diagnosis and treatment of this condition in children, 15 such cases seen at the Children's Hospital of Eastern Ontario between 1975 and 1991 were studied retrospectively. Case presentations were similar, with delayed onset of localized pain, swelling, and elevated erythrocyte sedimentation rate following a puncture wound. All patients had previously received oral antibiotics. Initial radiographic changes were rare. All patients were treated with i.v. antibiotics: although most required surgical debridement. Complications including recurrence, chronic pain, and deformities required sequestrectomies, angular osteotomies, and leg-lengthening procedures. A high index of suspicion, coupled with aggressive medical and surgical treatment, is required for a satisfactory outcome.