Study to evaluate the role of surgical management in acute osteomyelities in children

Abstract

INTRODUCTION: Acute hematogenous osteomyelitis is predominantly seen in children, accounting for 1% of all hospital admissions. It is a limb-and life-threatening condition with variable presentation, requiring prompt diagnosis and immediate treatment. Sequential intravenous and oral antibiotics, immobilization, surgical drainage and symptomatic measures are main treatment modalities for management of this condition. The aim of this study is to evaluate the role of surgical management in acute osteomyelitis. MATERIALS AND METHODS: Twenty-five children with acute hematogenous osteomyelitis were included in this cross-sectional retrospective study. Clinical, laboratory, and radiological data were collected and examined. Follow-up records of patients were analyzsed to note the status of healing, complications, and functional outcome. Data were analyzed using SPSS version 20, paired t-test, and Chi-square test. The chosen level of significance was P < 0.05. RESULTS: Sixty percent of the patients were male with average age of 7 years. The median duration of symptoms was 10 days. Sixty percent of the patients had a history of trauma. Tibia was most commonly involved followed by femur. Staphylococcus aureus was the most common organism isolated from the culture. Twenty-one patients were managed surgically. Average follow-up period was 4.2 months. At 3 weeks' follow-up, majority of the patients had reduction in pain and swelling. Twenty-two patients had a complete recovery. Three patients developed chronic osteomyelitis, two of them developed deformity. It was observed that surgical treatment was significantly associated with better outcome as compared to conservative management for acute osteomyelitis (P = 0.011). CONCLUSION: Surgical intervention is of at most importance in patients with acute osteomyelitis in the presence of abscess. Prompt surgical decompression with sequential intravenous-oral antibiotics gives an excellent outcome in the management of acute osteomyelitis in children.

Keywords

• acute osteomyelitis
• infection
• pediatric orthopedics
• surgical management