Selection of treatment modalities in children with chronic osteomyelitis

Objectives: We evaluated clinical and follow-up findings and treatment methods of pediatric patients with chronic osteomyelitis. Methods: The study included 22 children (14 boys, 8 girls; mean age 8±7 years) who were treated for chronic osteomyelitis. Infection sites were the femur, tibia, ulna, and radius in 11, 8, 1, and 2 patients, respectively. Sixteen patients had a history of trauma. Fourteen patients had frac¬tures, nine of which were associated with segmentary bone defects. All the patients underwent at least one debridement and received antibiotic treatment for at least six weeks. When necessary, medications were modified according to the antibiogram results. Cast immobilization was applied, but external fixation was used when bone instability exist¬ed. The mean follow-up period was 54 months. Results: Clinical improvement was achieved in 13 patients following surgical debridement procedures, antibiotic treatment for six weeks, secondary grafting (5 patients), and cast immobilization. Of nine patients with segmentary bone losses, seven patients needed bone reconstruction procedures. Spontaneous shaft regenera¬tion was observed in one patient with ulnar osteomyelitis. Conclusion: The results of surgical debridement and antibiotic treatment are satisfactory in more than half of the pediatric patients with chronic osteomyelitis. However, those developing segmentary bone defects after surgical debridement require bone reconstruction procedures.