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Successful treatment of chronic osteomyelitis in children with debridement, antibiotic-laden cement spacer and bone graft substitute

  • Original Article • PAEDIATRICS - INFECTION
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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Chronic osteomyelitis and infected nonunion are relatively rare conditions in pediatric patients and are more frequently seen in developing countries. Although relatively rare, they are medically and surgically challenging. Here we report a novel surgical technique used to manage five patients with chronic osteomyelitis of long bones.

Methods

Five skeletally immature patients with chronic osteomyelitis and infected nonunion of the long bones were treated surgically between 2010 and 2014 by a combination of resection of necrotic infected bone, debridement of surrounding soft tissue, and application of antibiotic-laden cement spacer inducing periosteal membrane before final bone reconstruction. Once inflammatory markers normalized, all the patients were re-operated for cement removal, bone graft substitution, and concomitant osteosynthesis of the affected bone, if needed. All patients underwent MRI, CT scan, and laboratory evaluation prior to surgery. The antibiotic regimen was started empirically and then adjusted according to culture and sensitivity results.

Results

Mean patient age at the time of diagnosis was 11 years (range 4–14), and all patients had at least 2-year follow-up (range 2–5). At last follow-up, clinical and laboratory evaluation had normalized, the bone had healed, and all patients had resumed daily living and sports activities.

Conclusion

Surgical debridement is the standard approach to chronic osteomyelitis. Use of antibiotic-laden cement is recommended to penetrate local infection, with antibiotic therapy playing an adjunctive role. The cement also induces membrane formation that aids bone reconstruction.

Level of evidence

IV.

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Acknowledgments

Institutional review board approval: The study was approved by the Clermont-Ferrand University Hospital Review Board.

Funding

None of the authors received financial support for this study.

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Correspondence to Federico Canavese.

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Conflict of interest

The authors declare that they have no conflicts of interest in this research.

Ethical approval

All procedures and studies involving human participants were performed in accordance with the ethical standards of the national and/or institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

No patients were involved. This is a retrospective study of patient’s data for which IRB approval was obtained.

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Cite this article

Canavese, F., Corradin, M., Khan, A. et al. Successful treatment of chronic osteomyelitis in children with debridement, antibiotic-laden cement spacer and bone graft substitute. Eur J Orthop Surg Traumatol 27, 221–228 (2017). https://doi.org/10.1007/s00590-016-1859-7

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  • DOI: https://doi.org/10.1007/s00590-016-1859-7

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