Chronic Osteomyelitis in Children: Treatment by Intramedullary Reaming and Antibiotic-impregnated Cement Rods
| Autor: | D. Weigl, Gilat Livni, Eyal Mercado, Noam Bor, Kalman Katz, Tali Becker, Elhanan Bar-On |
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| Rok vydání: | 2010 |
| Předmět: |
Male
medicine.medical_specialty Adolescent medicine.drug_class medicine.medical_treatment Antibiotics Risk Assessment Asymptomatic Sampling Studies law.invention Intramedullary rod Drug Delivery Systems law Fracture fixation medicine Humans Orthopedics and Sports Medicine Child Retrospective Studies Antibacterial agent Debridement business.industry Bone Cements Osteomyelitis General Medicine medicine.disease Combined Modality Therapy Fracture Fixation Intramedullary Surgery Radiography Treatment Outcome Chronic Disease Pediatrics Perinatology and Child Health Orthopedic surgery Gentamicins medicine.symptom Osteitis business Femoral Fractures Follow-Up Studies |
| Zdroj: | Journal of Pediatric Orthopaedics. 30:508-513 |
| ISSN: | 0271-6798 |
| DOI: | 10.1097/bpo.0b013e3181e00e34 |
| Popis: | Background Chronic osteomyelitis (CO) is rarely encountered in developed countries and is especially rare in children and adolescents. However, on occurrence, it can pose a difficult therapeutic challenge necessitating a combination of aggressive surgical treatment and prolonged antibiotic administration. Methods Four patients were treated for CO in the Pediatric Orthopaedic Unit at Schneider Children's Medical Center between June 2005 and December 2006 and were reviewed retrospectively. Surgical treatment consisted of debridement and lavage, reaming of the intramedullary canal and insertion of gentamycin-impregnated polymetamethacrylate rods into the canal and beads around the infection site. At rod removal reaming and lavage were repeated. Antibiotic treatment was initiated with intravenous cephalothin, followed by prolonged oral treatment according to bacterial sensitivity. Results Cement rods and beads were removed 16 to 62 days after insertion. Intravenous antibiotics were continued for 6 weeks (3-13) and total antibiotic treatment length was 16 weeks (10-37). Total treatment time from presentation to full resolution averaged 8 months (2-18). One patient sustained a fracture requiring osteotomy and correction. At mean follow-up of 41 months from rod removal (36-46), all patients are asymptomatic and fully functional with no clinical signs of infection. C-reactive protein is within normal limits in all 4 patients. Conclusions The method presented combining reaming, lavage and local and systemic antibiotic treatment was found to be safe and effective in the treatment of CO, eradicating the infection and preventing further tissue loss. Level of evidence Therapeutic study, clinical case series: level IV. |
| Databáze: | OpenAIRE |
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