Klinik Araştırma
BibTex RIS Kaynak Göster

The Use of Antibiotic-Impregnated Cement in the Surgical Treatment of Chronic Osteomyelitis in Children

Yıl 2025, Cilt: 7 Sayı: 2, 327 - 332, 09.05.2025
https://doi.org/10.37990/medr.1614823

Öz

Aim: Information in the literature related to paediatric chronic osteomyelitis is extremely limited as the disease can be prevented to a large extent in developed countries. The aim of this study was to evaluate the clinical and radiological results of patients treated with two-stage surgical debridement and antibiotic-impregnated cement because of chronic osteomyelitis, and to thereby contribute to the literature.
Material and Method: Two-stage surgical debridement and antibiotic-impregnated cement was performed because of chronic osteomyelitis in 8 patients (6 males, 2 females) with a mean age of 6 years (range, 2-11 years) between June 2018 and June 2022. Demographic data were recorded together with the time since the onset of symptoms, anatomic localisation, accompanying fractures, and laboratory parameters. Postoperatively, the patients were followed up in respect of infection recurrence, nephrotoxicity, and fracture healing with direct radiographs and laboratory tests.
Results: The mean follow-up period was 19 months (range, 12-30 months). The localisation of chronic osteomyelitis was determined to be the femur in 2 (25%) patients, the tibia in 3 (37%), the humerus in 2 (25%), and the radius in 1 (12%). In 3 (37%) patients with no history of trauma, the diagnosis made on first evaluation was osteomyelitis-related pathological fracture. No recurrence of infection was observed in any patient during the follow-up period after the final surgery. Full bone union was observed in the cases with accompanying fracture, and of these, deformity was determined in 2 and mild contracture in 1.
Conclusion: Paediatric chronic osteomyelitis can lead to severe problems of bone integrity, especially in cases which have been neglected or when presentation is delayed. Despite predictable complications, the application of antibiotic-impregnated cement may be effective in the context of providing infection eradication and bone union, which are the main treatment aims in this disease.

Etik Beyan

This study was carried out with the scope of the approval and information of Mogadishu Somalia Türkiye Recep Tayyip Erdoğan Training Research Clinical Research Ethics Committee (Date and Decision No: 07.09.2023 and 846).

Kaynakça

  • Dich VQ, Nelson JD, Haltalin KC. Osteomyelitis in infants and children. A review of 163 cases. Am J Dis Child. 1975;129:1273-8.
  • Gornitzky AL, Kim AE, O'Donnell JM, Swarup I. Diagnosis and management of osteomyelitis in children: a critical analysis review. JBJS Rev. 2020;8:e1900202.
  • Howard-Jones AR, Isaacs D. Systematic review of systemic antibiotic treatment for children with chronic and sub-acute pyogenic osteomyelitis. J Paediatr Child Health. 2010;46:736-41.
  • Hsieh PH, Tai CL, Lee PC, Chang YH. Liquid gentamicin and vancomycin in bone cement: a potentially more cost-effective regimen. J Arthroplasty. 2009;24:125-30.
  • Arnold JC, Bradley JS. Osteoarticular infections in children. Infect Dis Clin North Am. 2015;29:557-74.
  • Jaramillo D, Dormans JP, Delgado J, et al. Hematogenous osteomyelitis in infants and children: imaging of a changing disease. Radiology. 2017;283:629-43.
  • Howard JL, Buckley R, McCormack R, et al. Complications following management of displaced intra-articular calcaneal fractures: a prospective randomized trial comparing open reduction internal fixation with nonoperative management. J Orthop Trauma. 2003;17:241-9.
  • Hollmig ST, Copley LA, Browne RH, et al. Deep venous thrombosis associated with osteomyelitis in children. J Bone Joint Surg Am. 2007;89:1517-23.
  • Canavese F, Corradin M, Khan A, et al. Successful treatment of chronic osteomyelitis in children with debridement, antibiotic-laden cement spacer and bone graft substitute. Eur J Orthop Surg Traumatol. 2017;27:221-8.
  • Paley D, Herzenberg JE. Intramedullary infections treated with antibiotic cement rods: preliminary results in nine cases. J Orthop Trauma. 2002;16:723-9.
  • Bar-On E, Weigl DM, Bor N, et al. Chronic osteomyelitis in children: treatment by intramedullary reaming and antibiotic-impregnated cement rods. J Pediatr Orthop. 2010;30:508-13.
  • Andreacchio A, Alberghina F, Paonessa M, et al. Tobramycin-impregnated calcium sulfate pellets for the treatment of chronic osteomyelitis in children and adolescents. J Pediatr Orthop B. 2019;28:189-95.
  • Marais LC, Ferreira N. Bone transport through an induced membrane in the management of tibial bone defects resulting from chronic osteomyelitis. Strategies Trauma Limb Reconstr. 2015;10:27-33.
  • Ferguson JY, Dudareva M, Riley ND, et al. The use of a biodegradable antibiotic-loaded calcium sulphate carrier containing tobramycin for the treatment of chronic osteomyelitis: a series of 195 cases. Bone Joint J. 2014;96-B:829-36.
  • Jung J, Schmid NV, Kelm J, et al. Complications after spacer implantation in the treatment of hip joint infections. Int J Med Sci. 2009;6:265-73.
  • Menge TJ, Koethe JR, Jenkins CA, et al. Acute kidney injury after placement of an antibiotic-impregnated cement spacer during revision total knee arthroplasty. J Arthroplasty. 2012;27:1221-7.
  • Luu A, Syed F, Raman G, et al. Two-stage arthroplasty for prosthetic joint infection: a systematic review of acute kidney injury, systemic toxicity and infection control. J Arthroplasty. 2013;28:1490-8.
  • Yeo A, Ramachandran M. Acute haematogenous osteomyelitis in children. BMJ. 2014;348:g66. Erratum in: BMJ. 2014;348:1326.
  • Congedi S, Minotti C, Giaquinto C, et al. Acute infectious osteomyelitis in children: new treatment strategies for an old enemy. World J Pediatr. 2020;16:446-55.
  • Saavedra-Lozano J, Mejías A, Ahmad N, et al. Changing trends in acute osteomyelitis in children: impact of methicillin-resistant Staphylococcus aureus infections. J Pediatr Orthop. 2008;28:569-75.

Yıl 2025, Cilt: 7 Sayı: 2, 327 - 332, 09.05.2025
https://doi.org/10.37990/medr.1614823

Öz

Kaynakça

  • Dich VQ, Nelson JD, Haltalin KC. Osteomyelitis in infants and children. A review of 163 cases. Am J Dis Child. 1975;129:1273-8.
  • Gornitzky AL, Kim AE, O'Donnell JM, Swarup I. Diagnosis and management of osteomyelitis in children: a critical analysis review. JBJS Rev. 2020;8:e1900202.
  • Howard-Jones AR, Isaacs D. Systematic review of systemic antibiotic treatment for children with chronic and sub-acute pyogenic osteomyelitis. J Paediatr Child Health. 2010;46:736-41.
  • Hsieh PH, Tai CL, Lee PC, Chang YH. Liquid gentamicin and vancomycin in bone cement: a potentially more cost-effective regimen. J Arthroplasty. 2009;24:125-30.
  • Arnold JC, Bradley JS. Osteoarticular infections in children. Infect Dis Clin North Am. 2015;29:557-74.
  • Jaramillo D, Dormans JP, Delgado J, et al. Hematogenous osteomyelitis in infants and children: imaging of a changing disease. Radiology. 2017;283:629-43.
  • Howard JL, Buckley R, McCormack R, et al. Complications following management of displaced intra-articular calcaneal fractures: a prospective randomized trial comparing open reduction internal fixation with nonoperative management. J Orthop Trauma. 2003;17:241-9.
  • Hollmig ST, Copley LA, Browne RH, et al. Deep venous thrombosis associated with osteomyelitis in children. J Bone Joint Surg Am. 2007;89:1517-23.
  • Canavese F, Corradin M, Khan A, et al. Successful treatment of chronic osteomyelitis in children with debridement, antibiotic-laden cement spacer and bone graft substitute. Eur J Orthop Surg Traumatol. 2017;27:221-8.
  • Paley D, Herzenberg JE. Intramedullary infections treated with antibiotic cement rods: preliminary results in nine cases. J Orthop Trauma. 2002;16:723-9.
  • Bar-On E, Weigl DM, Bor N, et al. Chronic osteomyelitis in children: treatment by intramedullary reaming and antibiotic-impregnated cement rods. J Pediatr Orthop. 2010;30:508-13.
  • Andreacchio A, Alberghina F, Paonessa M, et al. Tobramycin-impregnated calcium sulfate pellets for the treatment of chronic osteomyelitis in children and adolescents. J Pediatr Orthop B. 2019;28:189-95.
  • Marais LC, Ferreira N. Bone transport through an induced membrane in the management of tibial bone defects resulting from chronic osteomyelitis. Strategies Trauma Limb Reconstr. 2015;10:27-33.
  • Ferguson JY, Dudareva M, Riley ND, et al. The use of a biodegradable antibiotic-loaded calcium sulphate carrier containing tobramycin for the treatment of chronic osteomyelitis: a series of 195 cases. Bone Joint J. 2014;96-B:829-36.
  • Jung J, Schmid NV, Kelm J, et al. Complications after spacer implantation in the treatment of hip joint infections. Int J Med Sci. 2009;6:265-73.
  • Menge TJ, Koethe JR, Jenkins CA, et al. Acute kidney injury after placement of an antibiotic-impregnated cement spacer during revision total knee arthroplasty. J Arthroplasty. 2012;27:1221-7.
  • Luu A, Syed F, Raman G, et al. Two-stage arthroplasty for prosthetic joint infection: a systematic review of acute kidney injury, systemic toxicity and infection control. J Arthroplasty. 2013;28:1490-8.
  • Yeo A, Ramachandran M. Acute haematogenous osteomyelitis in children. BMJ. 2014;348:g66. Erratum in: BMJ. 2014;348:1326.
  • Congedi S, Minotti C, Giaquinto C, et al. Acute infectious osteomyelitis in children: new treatment strategies for an old enemy. World J Pediatr. 2020;16:446-55.
  • Saavedra-Lozano J, Mejías A, Ahmad N, et al. Changing trends in acute osteomyelitis in children: impact of methicillin-resistant Staphylococcus aureus infections. J Pediatr Orthop. 2008;28:569-75.
Toplam 20 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Ortopedi
Bölüm Klinik Araştırma
Yazarlar

Hakan Cici 0000-0002-9511-4865

Hakan Zeybek 0000-0003-1525-9966

Osman Mohamed Abdulkarim 0009-0006-7613-631X

Kazım Kıratlı 0000-0001-8317-955X

Abdulkhalek Hassan Mohamed 0009-0000-2067-9231

Gürkan Yıldız 0000-0001-8471-4294

Gönderilme Tarihi 7 Ocak 2025
Kabul Tarihi 18 Şubat 2025
Yayımlanma Tarihi 9 Mayıs 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 7 Sayı: 2

Kaynak Göster

AMA 1.Cici H, Zeybek H, Mohamed Abdulkarim O, Kıratlı K, Hassan Mohamed A, Yıldız G. The Use of Antibiotic-Impregnated Cement in the Surgical Treatment of Chronic Osteomyelitis in Children. Med Records. 2025;7(2):327-332. doi:10.37990/medr.1614823

Chief Editors
Prof. Dr. Berkant Özpolat, MD
Department of Thoracic Surgery, Ufuk University, Dr. Rıdvan Ege Hospital, Ankara, Türkiye

Editors
Prof. Dr. Sercan Okutucu, MD
Department of Cardiology, Ankara Lokman Hekim University, Ankara, Türkiye

Assoc. Prof. Dr. Süleyman Cebeci, MD
Department of Ear, Nose and Throat Diseases, Gazi University Faculty of Medicine, Ankara, Türkiye

Field Editors
Assoc. Prof. Dr. Doğan Öztürk, MD
Department of General Surgery, Manisa Özel Sarıkız Hospital, Manisa, Türkiye

Assoc. Prof. Dr. Birsen Doğanay, MD
Department of Cardiology, Ankara Bilkent City Hospital, Ankara, Türkiye

Assoc. Prof. Dr. Sonay Aydın, MD
Department of Radiology, Erzincan Binali Yıldırım University Faculty of Medicine, Erzincan, Türkiye

Language Editors
PhD, Dr. Evin Mise
Department of Work Psychology, Ankara University, Ayaş Vocational School, Ankara, Türkiye

Dt. Çise Nazım
Department of Periodontology, Dr. Burhan Nalbantoğlu State Hospital, Lefkoşa, North Cyprus

Statistics Editor
Dr. Nurbanu Bursa, PhD
Department of Statistics, Hacettepe University, Faculty of Science, Ankara, Türkiye

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