Clinical features and sequelae of pediatric osteomyelitis following surgical treatment: a 10-year retrospective study.

AIM: Osteomyelitis (OM) in children is a severe infectious disease, and its sequelae are common. The purpose of this study was to analyze the clinical features and sequelae of pediatric patients following surgical treatment.

PATIENTS AND

METHODS

We reviewed all pediatric patients with OM at our clinical center who underwent surgical debridement and antimicrobial therapy from January 2013 to December 2023. Patients were followed for at least 1 year to evaluate clinical outcomes and the occurrence of sequelae. Risk factors associated with sequelae were analyzed via Logistic regression.

RESULTS

A total of 220 pediatric patients with a mean age of 11.69 ± 3.79 years were included. Of these, 151 (68.6%) were male. The majority were due to hematogenous infection (56.8%), while a significant proportion of patients had chronic infections with 149 (67.7%) had more than three month infection duration. The most frequently involved bones were the tibia (44.5%) and femur (29.5%). In addition, 103 patients (46.8%) had a detected pathogen, with Staphylococcus aureus (34.1%) being the most common, followed by Pseudomonas aeruginosa (4.1%) and Staphylococcus epidermidis (3.2%). After a median follow-up of 2 years (range: 1-6 years), 8 patients (3.6%) had infection recurrence; However, they were completely cured after revision surgery. A total of 37 patients (16.8%) reported sequelae, including growth arrest (n = 21), joint injury (n = 16), limb deformities (n = 7), chronic pain (n = 3), and pathologic fractures (n = 2). Regression analysis showed that the use of an external fixator (OR = 8.85, p = 0.001), traumatic infection (OR = 9.88, p = 0.002), prolonged infection duration (≥ 3 months) (OR = 8.00, p = 0.007), and multiple debridements (n ≥ 2) (OR = 5.49, p = 0.021) were risk factors for sequelae, after adjusting for the age and infection site of patients.

CONCLUSION

The data indicated that a significant proportion of children with traumatic and chronic OM suffered surgical intervention, although hematogenous infections remain the predominant type. Meanwhile, the infection cure was often achievable. However, clinicians should still be aware of the potential sequelae and related risk factors following surgical treatment.