Hematogenous osteomyelitis of the wrist in children
| Autor: | Keyvan Mazda, Georges F. Penneçot, Etienne Morel, Brice Ilharreborde, Estelle Litzelmann, Frank Fitoussi |
|---|---|
| Rok vydání: | 2007 |
| Předmět: |
musculoskeletal diseases
Male Wrist Joint medicine.medical_specialty Adolescent Wrist Bone Infection Diagnosis Differential Anti-Infective Agents Medicine Humans Orthopedics and Sports Medicine Child Retrospective Studies business.industry Osteomyelitis Medical record Infant Retrospective cohort study General Medicine Staphylococcal Infections medicine.disease Combined Modality Therapy Surgery body regions medicine.anatomical_structure Debridement Child Preschool Pediatrics Perinatology and Child Health Orthopedic surgery Female Methicillin Resistance Differential diagnosis Osteitis business |
| Zdroj: | Journal of pediatric orthopedics. 27(7) |
| ISSN: | 0271-6798 |
| Popis: | Wrist osteomyelitis is a rare infection, and few studies have been published about its prognosis and treatment.We retrospectively examined the medical records of 18 children older than 4 months who were diagnosed with wrist osteomyelitis. A definite diagnosis of wrist osteomyelitis required either confirmatory radiographic/bone scintigraphy changes associated with compatible clinical picture and elevated laboratory indices consistent with infection. The clinical evaluation was based on clinical and radiographic assessment at 1 week, 2 weeks, 3 months, 6 months, 1 year, and 2 years after the diagnosis.Delay between initial symptoms and treatment ranged from 1 to 45 days (mean, 7 days). The radiographs at diagnosis demonstrated a lytic zone in the distal radial or ulnar metaphysis in 5 cases. All patients were treated with 6 weeks' course of antibiotics with sequential parenteral (7 days)-oral with a third-generation cephalosporin (Cefotaxim) associated with Fosfomycin. Surgical debridement was needed in 5 cases because plain radiographs, ultrasonography, or magnetic resonance imaging (MRI) had confirmed the presence of an intraosseous or subperiosteal abscess. Seven isolated organisms were methicillin-susceptible Staphylococcus aureus, and 1 was methicillin-resistant S. aureus. The average follow-up was 2 years. Significant orthopaedic sequelae as distal radius/ulna epiphysiodesis were apparent in 2 patients.Wrist osteomyelitis is a severe infection with initial radiographic lytic zone in almost 30% of cases and with growth disturbance in 11% at the last follow-up. If we include the presence of intraosseous or subperiosteal abscess that required surgical debridement, the initial complication rate is 33%, which is superior to the 5% complication rate in the literature about general osteomyelitis. Misdiagnosis at initial clinical examination can explain this condition. |
| Databáze: | OpenAIRE |
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