Hematogenous osteomyelitis of the wrist in children.

Abstract

INTRODUCTION:

Wrist osteomyelitis is a rare infection, and few studies have been published about its prognosis and treatment.

METHODS:

We retrospectively examined the medical records of 18 children older than 4 months who were diagnosed with wrist osteomyelitis. A definite diagnosis of wrist osteomyelitis required either confirmatory radiographic/bone scintigraphy changes associated with compatible clinical picture and elevated laboratory indices consistent with infection. The clinical evaluation was based on clinical and radiographic assessment at 1 week, 2 weeks, 3 months, 6 months, 1 year, and 2 years after the diagnosis.

RESULTS:

Delay between initial symptoms and treatment ranged from 1 to 45 days (mean, 7 days). The radiographs at diagnosis demonstrated a lytic zone in the distal radial or ulnar metaphysis in 5 cases. All patients were treated with 6 weeks' course of antibiotics with sequential parenteral (7 days)-oral with a third-generation cephalosporin (Cefotaxim) associated with Fosfomycin. Surgical debridement was needed in 5 cases because plain radiographs, ultrasonography, or magnetic resonance imaging (MRI) had confirmed the presence of an intraosseous or subperiosteal abscess. Seven isolated organisms were methicillin-susceptible Staphylococcus aureus, and 1 was methicillin-resistant S. aureus. The average follow-up was 2 years. Significant orthopaedic sequelae as distal radius/ulna epiphysiodesis were apparent in 2 patients.

DISCUSSION:

Wrist osteomyelitis is a severe infection with initial radiographic lytic zone in almost 30% of cases and with growth disturbance in 11% at the last follow-up. If we include the presence of intraosseous or subperiosteal abscess that required surgical debridement, the initial complication rate is 33%, which is superior to the 5% complication rate in the literature about general osteomyelitis. Misdiagnosis at initial clinical examination can explain this condition.

• Authors: Frank Fitoussi, Estelle Litzelmann, Brice Ilharreborde, Etienne Morel, Keyvan Mazda, Georges F Penneçot
• Journal: Journal of pediatric orthopedics (J Pediatr Orthop) 2007 Oct-Nov Vol. 27 Issue 7 Pg. 810-3 ISSN: 0271-6798 [Print] United States
• PMID: 17878790 (Publication Type: Journal Article)

Chemical References

• Anti-Infective Agents

Topics

• Adolescent
• Anti-Infective Agents (therapeutic use)
• Child
• Child, Preschool
• Combined Modality Therapy
• Debridement
• Diagnosis, Differential
• Female
• Humans
• Infant
• Male
• Methicillin Resistance
• Osteomyelitis (diagnosis, microbiology, therapy)
• Retrospective Studies
• Staphylococcal Infections (diagnosis, therapy)
• Wrist Joint