Is Early Surgical Intervention Necessary for Acute Neonatal Humeral Epiphyseal Osteomyelitis: A Retrospective Study of 31 Patients

Gao, Yun; Liu, Ruikang; Rai, Saroj; Liang, Qingtuan; Liu, Yuan; Xiao, Xiaoliang; Hong, Pan

doi:10.3390/children9040527

Cited by 3 publications

(3 citation statements)

References 30 publications

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“…Surgery is indicated in more than 50 % of cases, though few studies in older children have reported improvement with antibiotics only in up to 90% of cases of acute osteomyelitis. [8][9][10][11] It not only helps in the drainage of pus and reduction of septic load for the patient, but it also provides an opportunity for culture, removal of dead bone, and lavage of local infection. All of our cases showed partial improvement with antibiotics and finally needed surgical intervention finally.…”

Section: Discussionmentioning

confidence: 99%

“…These sequelae sometimes take 8-10 years to develop and increase as the child grows. [11][12] Neonatal bone has various characteristics including extensive vascular supply and early resorption of cortical sequestra, favoring the prevention of chronic osteomyelitis. Neonates begin to remodel bone rapidly and thus allowing rapid and better healing as compared to older children.…”

Section: Discussionmentioning

confidence: 99%

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Neonatal osteomyelitis: A case series

et al. 2023

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Background: Osteomyelitis in the neonatal age group is a rare entity. Its presentation and progression are quite different from osteomyelitis in adults, adolescents, and even children. Due to vague clinical features and the late appearance of changes on X-rays, the diagnosis often gets missed. Additionally, there is a risk of permanent damage to bones and joints. Case Presentation: Our experience of 3 such interesting cases showed the diagnostic dilemma involved in neonatal osteomyelitis. All 3 cases presented as cellulitis or subcutaneous abscess initially as x-ray changes appeared late (7-10 days after onset of disease). All the babies needed surgical debridement. The average duration of antibiotics given was 35.5 days. No residual sequelae were reported for up to 2 years. Conclusion: Neonatal osteomyelitis needs a high index of suspicion especially in late-onset neonatal sepsis or prolonged septicemia. This case series emphasizes the need for a low threshold for suspicion and early treatment to avoid permanent disability.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Neonatal osteomyelitis: A case series

et al. 2023

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“…The most common single sites of infection are the tibia, femur, and phalanges in that order [7]. The United States 2021 guidelines for the diagnosis and management of acute HO in pediatrics recommend blood culture and bone biopsy as the diagnostic criteria, with bone biopsy having a higher diagnostic yield [8], and HO treatment consists of antibiotics and surgery [9]. However, there are numerous surgical treatment options, and currently, there is still a lack of uni ed standards for the selection of surgical indications and methods [10].…”

Section: Introductionmentioning

confidence: 99%

Comparative analysis of the efficacy of drip drainage surgery and bone cement placement surgery in the treatment of haematogenous osteomyelitis of the extremities

Wang,

Lu,

Luo

et al. 2024

Preprint

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Background: The classical surgical treatment for hematogenous osteomyelitis is debridement and drip drainage surgery, and in recent years, antibiotic bone cement placement surgery has gradually gained widespread use. Method: Information on 129 Hematogenic osteomyelitis (HO) patients, 67 treated with bone cement placement surgery and 62 with drip drainage surgery, was collected from January 2015 to January 2023. Baseline data, osteomyelitis classification, and clinical regression were compared between the two groups, with a mean follow-up of 2 years. Result: Bone cement placement surgery had a higher infection control rate than drip drainage surgery (94% vs. 82.3%, P<0.001), and the EuroQol five-dimensional questionnaire (EQ-5D-3L)effect value was higher (0.763±0.29 vs. 0.717±0.42, P = 0.192). The efficacy of drip drainage surgery for Acute Hematogenic Osteomyelitis (AHO) was greatly improved, and the overall infection control rate was increased from 82.3% to 93.1%, which was even slightly higher than that of bone cement placement surgery (P = 0.452); bone cement placement surgery had a higher rate of infection control in chronic patients (94.5% vs. 72.7%, P = 0.004) and was more effective in treating metaphyseal focal osteomyelitis (97.5% vs. 71.4%, P = 0.002). The use of calcium sulfate calcium phosphate complex (CS/CP) was superior to polymethylmethacrylate (PMMA) (100% vs. 88.69%, P<0.001). Conclusion: Bone cement placement surgery is recommended for the treatment of HO; drip drainage surgery is only indicated for AHO with long marrow cavity lesions; and CS/CP bone cement is preferred to PMMA, which requires a second removal to achieve good results because failure to remove it predisposes to recurrence of osteomyelitis.

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Surgical Management of an Osteomyelitis Associated Subchondral Bone Defect in the Pediatric Knee Based on Arthroscopy, “Ossoscopy” and Bone Grafting—A Case Report

Weber

Migliorini

Delbrück

et al. 2022

Life

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Subchondral bone defects around the knee joint are uncommon in skeletally immature patients. These lesions require comprehensive management, especially if related to periarticular bacterial infections. While pediatric osteomyelitis typically affects the metaphysis of long bones, the epiphysis is also a potential site for pyogenic osteomyelitis. Long-term sequelae may include growth plate injury and articular cartilage degradation. Primary epiphyseal subacute osteomyelitis is an extremely rare condition, mainly affecting neonates or young infants, as the cartilage of the growth plate generally acts as a barrier for pathogens. Radiographically, the lesions may appear radiolucent or lytic and often demonstrate a substantial perilesional bone marrow edema in MRI studies, but do not primarily contact the articular surface. However, if diagnosis and treatment of epiphyseal infections are delayed or missed, abscess formation may spread into the knee joint and progress to septic arthritis. Approaching a distal femoral epiphyseal lesion or subsequent bone defect surgically may be limited anatomically by both the subchondral plate and articular cartilage on the distal side and the growth plate proximally. Of the few reported cases of epiphyseal osteomyelitis, most underwent non-operative treatment including antibiotic coverage, or (staged) aggressive surgical care involving open curettage, irrigation and bone grafting. We report a novel combination of arthroscopic techniques, namely “ossoscopy”, bone grafting and antibiotics, to approach a large lateral femoral epiphyseal lesion with knee involvement. In this case report, we present a 5-year old male patient with subacute posttraumatic knee pain and a significant bone defect of the lateral femoral epiphysis related to pyogenic osteomyelitis. The knee joint and periarticular bone lesion were both debrided and irrigated based on arthroscopic and ossoscopic techniques.The osseous lesion was filled with bone graft. The single-stage procedure proved to be a viable treatment to restore both the large subchondral bone defect and full knee function. Over a course of two years, no recurrent symptoms, infection or growth disturbances were observed in the individual.

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Is Early Surgical Intervention Necessary for Acute Neonatal Humeral Epiphyseal Osteomyelitis: A Retrospective Study of 31 Patients

Cited by 3 publications

References 30 publications

Neonatal osteomyelitis: A case series

Neonatal osteomyelitis: A case series

Comparative analysis of the efficacy of drip drainage surgery and bone cement placement surgery in the treatment of haematogenous osteomyelitis of the extremities

Surgical Management of an Osteomyelitis Associated Subchondral Bone Defect in the Pediatric Knee Based on Arthroscopy, “Ossoscopy” and Bone Grafting—A Case Report

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