Late sequelae of osteoarticular infections in pediatric patients: A single-center study

To review the orthopedic sequelae of pediatric patients diagnosed with osteoarticular infections (OAIs) and identify significant differences between those with and without sequelae. Medical charts between 2010 and 2016 from a tertiary-care pediatric hospital were reviewed to collect demographic and clinical data for this retrospective case series. The main inclusion criteria were: 1. age (≤10 years old); 2. absence of sickle cell anemia and immunocompromising disease or medication; 3. a minimum follow-up of 12 months with radiographs; and 4. diagnosis of osteomyelitis of long bones and/or septic arthritis. The following late sequelae were observed and aggregated: osteal deformations that led to limb-length discrepancies (LLD) superior to 5 mm, abnormal articular angulations of more than 5°, and symptomatic chondropathies visible on imaging studies after 1 year. The patients were divided into 2 subgroups: with and without sequelae. Chi-Squared tests were used for categorical variables and Mann–Whitney U tests for continuous data to identify statistically significant differences between the 2 subgroups. Among 401 patients with osteomyelitis and/or septic arthritis, 50 (12.5%) were included (24 girls and 26 boys). There were 36 (72%) cases of osteomyelitis, 8 (16%) cases of septic arthritis, and 6 (12%) cases of combined infection (3 acute/subacute and 3 chronic cases). Five (10%) patients had orthopedic sequelae at the latest follow-up. The total duration of antibiotic treatment (P = .002), infectious disease follow-up (P = .002), and the presence of sequestra (P = .005) were significantly different between subgroups. There were no statistically significant differences between the 2 subgroups for the other variables, but some trends could be discerned. Only 4/50 patients developed a sequestrum, 2 of which were in the orthopedic sequelae subgroup. Furthermore, initial C-reactive protein (CRP) values were higher in the sequelae subgroup, as were the CRP values at hospital discharge. The orthopedic follow-up was also longer in the sequelae subgroup. Finally, the delay between the onset of symptoms and the beginning of antibiotic treatment was longer in the sequelae group. Patients with orthopedic sequelae had a longer antibiotic treatment and infectious disease follow-up, and were more likely to have presented with a sequestrum. Level of evidence: IV – case series.

Correction of deformity and shortening due to post traumatic epiphyseal arrest by distraction osteogenesis

Growth arrest in the epiphyseal plate during childhood often causes both periarticular deformities and limb length discrepancy, leading to compartmental osteoarthrosis and gait disturbance or spinal disorders, respectively. Distraction osteogenesis using external fixators with hinge systems appears to be useful for the simultaneous correction of deformity and shortening. In this paper, we evaluated cases of lower limbs with periarticular deformities and limb length discrepancy after epiphyseal plate injury that has been treated by distraction osteogenesis using external fixators. This is the first report regarding the outcomes of distraction osteogenesis for a group of patients having deformity and limb length discrepancy due to traumatic arrest of the physis. Successful outcomes may promise the use of this method as the first choice for the treatment of growth disorders after the arrest of the epiphyseal plate in the lower limbs. However, treatment under 20 years of age may provide a better outcome with a lower incidence of complications.