The Journal of Bone and Joint Surgery, Vol 71, Issue 10 1448-1468, Copyright © 1989 by Journal of Bone and Joint Surgery, Inc
Treatment of sequestra, pseudarthroses, and defects in the long bones of children who have chronic hematogenous osteomyelitis
A Daoud and A Saighi-Bouaouina
Orthopedic Pediatric Department, Centre Hospitalier et Universitaire, Douera, Algeria.
We reviewed the results, after follow-up ranging from twenty-three months
to six years, in thirty-four patients who were treated during childhood for
hematogenous osteomyelitis of a major long bone complicated by
sequestration of a portion of the diaphysis and by pseudarthrosis or
segmental bone loss, or both. Of the thirty-four lesions, twenty-four were
in the tibia, eight were in the femur, and two were in the humerus. In
twenty-three patients (Group I), the infection was still active, while in
the other eleven (Group II), it was quiescent at the time of admission to
the hospital. In nine of the patients in Group I (four tibial and five
femoral lesions), an involucrum bridged the osseous defect, indicating that
the periosteal tube had not been destroyed. In these nine patients,
sequestrectomy and debridement, appropriate antibiotic therapy, and
prolonged immobilization in a plaster cast resulted in healing of the
defect without recurrence of the infection. In the remaining fourteen
patients (twelve tibial and two femoral lesions), there was no periosteal
new-bone formation, and operative treatment consisted of two stages: the
first, to resolve the infection, and the second, to heal the osseous defect
with corticocancellous iliac grafts. In the eleven patients in Group II
(eight tibial, one femoral, and two humeral lesions), there were no
involucra. All of these patients were treated with cancellous bone grafts
and prolonged immobilization. In twenty-two of the thirty-four patients
(thirteen in Group I and nine in Group II), there were varying degrees of
angular deformity at the pseudarthrosis, necessitating correction by
manipulation when the plaster cast was applied postoperatively (ten
patients), by fibular transposition (six patients), or by fibular osteotomy
in addition to manipulation (six patients). Excluding complications
specific to the fibular transfer procedure, the complications in the
Group-I patients (six recurrent postoperative infections, one fracture of
the graft, and one non-union of a fibular strut graft) were approximately
as frequent as those in the Group-II patients (one failure of fusion and
two fractures of the graft). Operative treatment resulted in healing of all
but one tibial lesion, in a patient who nonetheless had good function at
follow-up. Of the seven limb-length discrepancies of 2.8 centimeters or
more, by the latest follow-up two had been treated uneventfully: one by
femoral and the other by tibial lengthening.(ABSTRACT TRUNCATED AT 400
WORDS)
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