Abstract
The authors call attention to the fact that puncture wounds of the foot are often considered simple, but can have potentially serious complications and sequelae.
In the majority of the cases, osteomyelitis in children is a haematogenous infection and the microorganism involved is a gram-positive coccus. The role of the puncture wound in osteomyelitis has been overlooked in the past. We present our experience with six cases of osteomyelitis following deep puncture wounds of the foot.
We reviewed six cases (1990–1999) of pseudomonas osteomyelitis in children. At the time of the injuries, five cases were boys younger than the age of seven and one was 12 years old. The sites affected were: metatarsal (2), phalanx (2) and calcaneous (2). The cause of injury was tree splinter (2), fork (1), needle (2) and nail (1). At the time of injury, all of the wounds contained foreign matter that was not initially completely removed and osteomyelitis developed as a result. The time interval until definitive diagnosis ranged from 5 to 730 days.
There is a similar history in all of the cases. For two or three days following the injury, the symptoms showed improvement and the injured site became swollen, tender, and painful afterwards. Treatment in all cases was hospitalisation, debridement and parenteral antibiotics for 18 to 22 days. After hospitalisation, an oral antibiotic (ciprofloxacin) was taken in two cases for three months and in four cases for four months.
After treatment, mean follow-up was 60 months (range 8 to 98 months). We have had no sequelae, recurrences or early growth arrest, and we consider the results to be good in all of the cases.
Puncture wounds of the foot should not be considered as “simple” injuries. Proper initial treatment is critical for the prevention of subsequent and potentially serious complications.
The abstracts were prepared by David P. Davlin. Correspondence should be addressed to him at the Orthopedic Clinic Bulovka, Budínova 2, 18081 Prague 8, Czech Republic.
