Factors associated with corticotomy in children with osteomyelitis.

BACKGROUND

This study evaluates critical associations between clinical, laboratory, and imaging findings with corticotomy status in children with osteomyelitis to learn what factors guide the decision to perform a corticotomy during surgical debridement.

METHODS

A retrospective review of children (<18 years old) with osteomyelitis was performed in a single health system. Demographic data and lab values were reviewed in addition to pre-procedure contrast-enhanced MRI imaging findings to detect the presence of intraosseous abscess or necrosis and operative reports for corticotomy status. Statistical analysis was performed using Wilcoxon rank sum, Pearson's Chi-squared, and Fisher's exact test where appropriate with a p-value of <0.05 considered statistically significant.

RESULTS

124 patients with confirmed osteomyelitis were analyzed, of which 81% (100/124) underwent a corticotomy during surgical debridement. 63% (63/100) of patients who underwent corticotomy had confirmed osseous abscess or necrosis on MRI compared to only 21% (5/24) who did not (p < 0.001). Most patients who had intraosseous abscess or necrosis on contrast-enhanced MRI (93% or 63/68 patients) underwent corticotomy. Patients who underwent corticotomy were found to have a higher median age than those who did not (8.0 years versus 2.0 years respectively, p = 0.001) and those who underwent corticotomy had lower WBC counts than those who did not (9.12 cells/µL versus 11.10 cells/µL respectively, p = 0.007).

CONCLUSIONS

There is a significant association between the presence of osseous abscess or necrosis on contrast-enhanced MRI and surgical corticotomies performed during debridement in pediatric patients. These findings highlight the importance of both imaging-guided diagnosis and clinical intraoperative assessment in treating pediatric osteomyelitis.