[Treatment of acute and chronic osteomyelitis in children]

Dieckmann R, Hardes J, Ahrens H, Flieger S, Gosheger G, Götze C, Rödl R

Abstract

AIM: Different studies in the past have reported about the treatment of osteomyelitis. None of these analysed the long-term results and complications after surgical treatment of acute and chronic osteomyelitis. The aim of this study was to analyse the recurrence rate and sequelae of osteomyelitis patients. PATIENTS AND METHODS: We analysed 53 children who were treated surgically between 1992 and 2004 for acute (n = 13) and chronic (n = 40) osteomyelitis. The histopathology was used for differentiation. With an average follow-up of 7.1 years (2 - 12.5 years) we examined the recurrence rate and the medical condition. RESULTS: A causative organism was identified in 53.9 % of the children with acute (AOM) and in 17.5 % of the children with chronic osteomyelitis (COM). In most cases Staphylococcus aureus could be isolated. Local antibiotics were applied intraoperatively to 92.3 % of the children with AOM and to 90 % of the children with COM. Additionally, the children with AOM were treated for 56.7 days (14 - 104 days) and the children with COM for 49.1 days (6 - 130 days) with parenteral/oral antibiotics. 2 (15.4 %) children with AOM and 6 (15 %) children with COM had a recurrence. At the time of the last examination all children were free of recurrence. One of the patients with AOM had a painless motion deficit of the shoulder. 5 children with COM complained of either pain and reduced range of motion of the affected extremity or minor deformities. CONCLUSION: Infantile osteomyelitis requires a selective diagnostic approach and an immediate parental antibiosis. If the antibiotic treatment fails, abscesses or sequestra are formed, an operation is indicated. With an adequate multidisciplinary cooperation, recurrence and sequelae can be avoided.