Abstract
Acute osteomyelitis of the radius or ulna in children is rare and may be associated with complications including pathological fracture, growth disturbance and cosmetic problems.
Purpose:
To highlight the outcome of acute pyogenic osteomyelitis of the forearm bones in children.
Methods:
Eleven children were treated for osteomyelitis of the radius (6) and ulna (5) over 15 years. Staphylococcus aureus was cultured following initial incision and drainage. Two had signs of compartment syndrome.
Late complications included gap defects of 2–6 cm (radius 1 and ulna 2). Larger defects with physeal involvement were seen in the distal ulna (4) proximal radius (1) and whole radius (1).
The late clinical features included pseudarthrosis (9), distal radioulnar instability (3), radial head dislocation (3) and “radial clubhand” type deformity (1).
Treatment:
Gap defects <2 cm were filled with autogenous grafts (3). Segmented iliac crest grafts threaded over a K wire were used in 1 patient with an 8 cm gap defect. Radio-ulnar synostosis was performed in 4 cases. The carpus was centralized onto the ulna in 1 child.
Results:
Reconstructive grafts healed by 6–12 weeks. Residual elbow contracture <30° occurred in 3 children. Ten children had improved grip strength and stability of the wrist and elbow and forearm length was decreased by 2–5 cm. The child with a radial clubhand deformity had severe shortening and stiffness of the hand.
Conclusion:
Osteomyelitis of the forearm bones can be missed and present late. Complications include disproportionate growth, proximal or distal radio-ulnar instability and radial clubhand type deformity. Treatment is challenging requiring reconstruction of gap defects. Radio-ulnar synostosis is a useful salvage procedure to improve function and cosmesis.
