A Rare Case of Clavicle Osteomyelitis in a Child and Literature Review

Abstract

Acute clavicle osteomyelitis in children is rare representing <3% of osteomyelitis cases. We treated a 12-year-old boy who presented with acute pain in the right clavicle and high fever for 4 days. MRI showed abnormal signal in the right clavicle with periosteal reaction. Staphylococcus aureus isolated from blood was susceptible to methicillin, clindamycin, and macrolides. Clindamycin was given intravenously for 3 wks and orally for another 3 wks with no recurrence. We reviewed clavicle osteomyelitis cases in children searching PubMed English literature. From a total of 89 studies retrieved, only 6 fulfilled the criteria and were analyzed. Sixteen patients (56% female) were included with a median age of 9 yrs (range 2 wks–16 yrs). Osteomyelitis was hematogenous in most cases, with S. aureus being the most frequent cause, isolated from either blood or tissue. Symptoms included fever, swelling, and localized bone tenderness. Antimicrobial therapy lasted for 4–12 weeks (median 7.5). Three patients required drainage or curettage. Recurrence occurred in 1/16 cases (6.2%) and persistence of symptoms occurred to 2/16 cases (12.5%) reported before 90s with unknown antimicrobial susceptibility of the pathogen. Acute clavicle osteomyelitis mainly affects older children and has generally good prognosis. Staphylococcus aureus is most commonly implicated and surgery may be needed.

Orak Hücreli Anemili Bir Çocukta Nadir Bir Komplikasyon: Klaviküler Osteomiyelit

“…Patolojik kırıklar ve herhangi bir nedenle kan akışının bozulması medial segmentin osteolizisine zemin hazırlayabilir. Bu nedenle klaviküler osteomiyelit diğer yassı kemikler gibi uzun kemiklere kıyasla daha zor tedavi edilebilmektedir (6).…”

“…Klaviküler osteomiyelitin nadir olması ve travma, fraktür, selülit, yumuşak doku apsesi, iskemik nekroz, tümör, kronik rekürren multifokal osteomiyelit gibi ayırıcı tanıda yer alan hastalıklarla klinik ve/veya radyolojik benzerliği tanı güçlüklerine neden olmaktadır (6,8). Hastalar sıklıkla akut başlangıçlı ateş, ağrı, omuzda şişlik, hareketlerde kısıtlılık, kızarıklık, krepitus gibi semptomlarla başvururlar.…”

“…Bu amaçla ilk basamak tedavi uygun antimikrobiyal ajanlarla yapılmalıdır. Ampirik tedavide kullanılan bu antimikrobiyaller; osteomiyelitin en sık etkeni olan S. aureus'u kapsayacak antistafilokokal penisilin, klindamisin, birinci kuşak sefalosporin ve metisiline dirençli S. aureus'un toplumda > %10 olarak görüldüğü bölgelerde klindamisin veya vankomisini içermelidir (6). Osteomiyelit için standart antibiyotik tedavisi süresi 4-6 haftadır.…”

“…Ancak nadir de olsa klavikula, kaburga, omurga, el ve ayak kemiklerinde osteomiyelit gelişebilir. Tüm kemikler içinde klavikula tutulumu %1-3 olarak bildirilmiştir (6,7). Klaviküler osteomiyelit hematojen yol, komşuluk yolu ya da travmaya bağlı oluşabilir.…”

Substantiation Stages of Rehabilitation at the Patients with Metaepiphyseal Osteomyelitis

“…A collective of authors [27] proved that acute clavicle osteomyelitis in children is rare representing <3% of osteomyelitis cases. Osteomyelitis was hematogenous in most cases, with S. aureus being the most frequent cause, isolated from either blood or tissue.…”