Abstract
Introduction
The management of pathologic fractures (PF) following osteomyelitis (especially acute subtype) has not been widely investigated. This is challenging due to the infection-induced destructive process causing bone architecture defects. Therefore, this study aims to assess a stepwise treatment plan for the acute incidence of PF in long bone following pediatric acute Hematogenous osteomyelitis(AHO) (the most common mechanism in children).
Method
This case series was conducted in a tertiary pediatric center. Patients with fracture incidence within the first 10 days after AHO diagnosis were included. Patients’ characteristics were retrospectively reviewed.
Result
Nine patients (7 boys, involved bone: the femur(4), tibia(3), Radius(1), and Ulna(1)) were included, with a mean age of 52.56±66.18 months (7-216) and a follow-up time of 11.62±3.61 years (6.5-16 years). The etiology in all patients was hematological(Methicillin-resistant Staphylococcus aureus).
Our stepwise treatment plan was as follows:
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1.
Intravenous antibiotics until ESR<20, then oral to ESR<5
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2.
Debridemnt surgery was performed if abscesses were detected.
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3.
Fracture type determined initial fixation: external fixation (4 patients, 2 unions) or casting (2 patients, both unions).
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4.
If the union was not obtained, internal fixation (with (2 patients) or without (2 patients) bone graft) was applied (all obtained union).
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5.
Circular external fixation was applied if the union was not obtained or leg length discrepancy occurred (1 case).
A mean of 3.2 surgical procedures (1-6) was required to control the infection, and 1.4 surgical procedures (0-4) were required to obtain union.
Except for one patient who died of septic shock, all other patients (88.8%) reached complete recovery (average length of hospital stay of 19.2 days (5-35).), and the union was obtained (the average union time of 17.25 months(4-36)) without long-term sequelae of osteomyelitis.
Conclusion
The outcome of the stepwise plan in this study suggests that acute PF following AHO in pediatrics can be managed efficiently.
