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Hospach T, Kallinich T, Martin L, V Kalle T, Reichert F, Girschick HJ, Hedrich CM. [Arthritis and osteomyelitis in childhood and adolescence-Bacterial and nonbacterial]. Z Rheumatol 2024:10.1007/s00393-024-01504-z. [PMID: 38653784 DOI: 10.1007/s00393-024-01504-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/25/2024]
Abstract
Bacterial arthritis and osteomyelitis are usually acute diseases, which in this way differ from the often insidious course of nonbacterial osteomyelitis; however, there is often an overlap both in less acute courses of bacterial illnesses and also in nonbacterial osteitis. The overlapping clinical phenomena can be explained by similar pathophysiological processes. In bacteria-related illnesses the identification of the pathogen and empirical or targeted anti-infectious treatment are prioritized, whereas no triggering agent is known for nonbacterial diseases. The diagnostics are based on the exclusion of differential diagnoses, clinical scores and magnetic resonance imaging (MRI). An activity-adapted anti-inflammatory treatment is indicated.
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Affiliation(s)
- T Hospach
- Zentrum für Pädiatrische Rheumatologie, Olgahospital, Klinikum Stuttgart (ZEPRAS), Kriegsbergstr 62, 70176, Stuttgart, Deutschland.
| | - T Kallinich
- Klinik für Pädiatrie m.S. Pneumologie, Immunologie und Intensivmedizin, Charité, Universitätsmedizin Berlin, Berlin, Deutschland
| | - L Martin
- Klinik für Pädiatrie m.S. Pneumologie, Immunologie und Intensivmedizin, Charité, Universitätsmedizin Berlin, Berlin, Deutschland
| | - T V Kalle
- Radiologisches Institut, Olgahospital, Klinikum Stuttgart, Stuttgart, Deutschland
| | - F Reichert
- Pädiatrische Infektiologie, Olgahospital, Klinikum Stuttgart, Stuttgart, Deutschland
| | - H J Girschick
- Vivantes Klinikum Friedrichshain, Berlin, Deutschland
| | - C M Hedrich
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, Großbritannien
- Department of Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, Großbritannien
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Malik J, Swanson RJ, Okimoto R, Khaled S. Disturbance of Growth in Pediatric Patients Due to Osteomyelitis Caused by Growth Plate Infection. Cureus 2023; 15:e50631. [PMID: 38226077 PMCID: PMC10789496 DOI: 10.7759/cureus.50631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/17/2024] Open
Abstract
Osteomyelitis, a severe bone infection, poses a multifaceted challenge to healthcare professionals. While its pathophysiology and treatment have been extensively studied, the impact of osteomyelitis on skeletal growth, particularly in pediatric patients, is an area that warrants attention. This abstract highlights the significance of understanding and managing growth disturbances in osteomyelitis, providing key findings and recommendations for clinicians. Understanding growth disturbance in osteomyelitis is essential because it can lead to lifelong consequences for pediatric patients. The infection may affect the growth plate, leading to limb length discrepancies, angular deformities, and functional impairments. These complications not only diminish the quality of life but also pose a substantial economic burden on the healthcare system. Therefore, early recognition and intervention are crucial. Key findings indicate that the risk of growth disturbances in osteomyelitis is particularly high in pediatric patients due to the vulnerability of the growth plate. Timely diagnosis, appropriate management, and targeted interventions can mitigate the long-term sequelae of growth disturbances. These include utilizing advanced imaging techniques to assess the extent of growth plate involvement, optimizing antibiotic therapy, and employing surgical techniques like epiphysiodesis, guided growth, or corrective osteotomies. Additionally, fostering a multidisciplinary approach that involves orthopedic surgeons, infectious disease specialists, and pediatric endocrinologists is vital to achieving successful outcomes. Recommendations for managing growth disturbance in osteomyelitis encompass early detection, meticulous monitoring, and a tailored treatment plan. Healthcare providers should remain vigilant for signs of growth plate involvement in osteomyelitis patients, especially in the pediatric population. A thorough evaluation, including advanced imaging and clinical assessment, is essential for accurate diagnosis. Close collaboration between specialists to address the infection and its skeletal consequences is crucial. Furthermore, patient and family education plays a pivotal role in fostering compliance with the treatment regimen. In conclusion, understanding and managing growth disturbances in osteomyelitis is paramount, particularly in pediatric patients. The implications of growth plate involvement are significant, and timely intervention is essential to prevent lifelong consequences. By implementing a comprehensive approach that combines accurate diagnosis, multidisciplinary collaboration, and patient education, healthcare professionals can enhance the quality of life and well-being of those affected by this challenging condition.
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Affiliation(s)
- Jamal Malik
- Department of Research, Liberty University College of Osteopathic Medicine, Lynchburg, USA
| | - R James Swanson
- Department of Research, Liberty University College of Osteopathic Medicine, Lynchburg, USA
| | - Richard Okimoto
- Department of Research, Liberty University College of Osteopathic Medicine, Lynchburg, USA
| | - Syed Khaled
- Gastroenterology, North Kansas City Hospital, Kansas City, USA
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Contreras JJ, Díaz A, Beltrán M. Extensive humeral defect secondary to humeral shaft nonunion and chronic osteomyelitis treated with induced membrane technique augmented with fibula autograft: a case report. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:446-456. [PMID: 37588721 PMCID: PMC10426561 DOI: 10.1016/j.xrrt.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Julio J. Contreras
- Shoulder and Elbow Unit, Instituto Traumatológico, Santiago, Chile
- Department of Orthopedics and Trauma, Universidad de Chile, Santiago, Chile
- Shoulder and Elbow Unit, Pontifical Catholic University of Chile, Santiago, Chile
- Department of Orthopedics and Trauma, Pontifical Catholic University of Chile, Santiago, Chile
| | - Alonso Díaz
- Shoulder and Elbow Unit, Instituto Traumatológico, Santiago, Chile
- Department of Orthopedics and Trauma, Universidad de Chile, Santiago, Chile
| | - Manuel Beltrán
- Shoulder and Elbow Unit, Instituto Traumatológico, Santiago, Chile
- Department of Orthopedics and Trauma, Universidad de Chile, Santiago, Chile
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El-Sobky T, Mahmoud S. Acute osteoarticular infections in children are frequently forgotten multidiscipline emergencies: beyond the technical skills. EFORT Open Rev 2021; 6:584-592. [PMID: 34377550 PMCID: PMC8335954 DOI: 10.1302/2058-5241.6.200155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Acute osteoarticular infections (AOI) should be treated as top emergencies. The first few days following the inception of infection are ultra-critical to long-term prognosis.A comprehensive road map for management of childhood AOI is still lacking despite recent advances in microbiology and imaging (magnetic resonance imaging). The many faces of childhood AOI warrant a multidiscipline approach to management.Laboratory and imaging findings of are still debatable and should not overshadow or delay a management plan based on the experienced physician's clinical judgment.Ample evidence-based practice supports the use of a few days of intravenous antibiotic administration followed by oral therapy until correlative clinical and basic laboratory (acute phase reactants) results improve.The growing body of evidence on 'high-risk' children/neonates of AOI warrants continual clinical extra-vigilance in identifying these patient subsets.Open drainage and debridement remain the mainstay of treatment of septic hips, whereas for other joints the use of alternative surgical techniques should be individualized or on case-by-case basis.Because the consequences of misdiagnosis of AOI are usually grave and permanent, proactive treatment/overtreatment is justified in the event of unconfirmed but suspicious diagnosis. Cite this article: EFORT Open Rev 2021;6:584-592. DOI: 10.1302/2058-5241.6.200155.
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Affiliation(s)
- Tamer El-Sobky
- Division of Paediatric Orthopaedics, Department of Orthopaedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Shady Mahmoud
- Division of Paediatric Orthopaedics, Department of Orthopaedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Onishi O, Kida Y, Kiba T, Kabuto Y, Minami M, Nishimura A, Konishi E, Takahashi K. Cryptococcal Osteomyelitis of the Entire Humerus: A Case Report. JBJS Case Connect 2021; 10:e2000279. [PMID: 33749226 DOI: 10.2106/jbjs.cc.20.00279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We describe a case of cryptococcal osteomyelitis in a 70-year-old man who presented with left elbow and shoulder pain. Subsequent imaging indicated osteomyelitis of the entire humerus, and he underwent debridement of the elbow and shoulder. Pathological findings revealed Cryptococcus neoformans infection. Surgical management was followed by a prolonged course of antibiotics. CONCLUSION Although C. neoformans is rare as the etiology of infection of the entire humerus, orthopaedic surgeons should consider cryptococcosis as a potential cause of infection.
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Affiliation(s)
- Okihiro Onishi
- 1Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan 2Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Wu H, Yu S, Fu J, Sun D, Wang S, Xie Z, Wang Y. Investigating clinical characteristics and prognostic factors in patients with chronic osteomyelitis of humerus. BURNS & TRAUMA 2019; 7:34. [PMID: 31844634 PMCID: PMC6894245 DOI: 10.1186/s41038-019-0173-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 10/01/2019] [Indexed: 12/03/2022]
Abstract
Background Chronic osteomyelitis in the humerus, which has complex neuroanatomy and a good soft tissue envelope, represents a unique clinical challenge. However, there are relatively few related studies in the literature. This article retrospectively reviewed a large case series with the aims of sharing our management experiences and further determining factors associated with the outcomes. Methods Twenty-eight consecutive adult patients with a mean age of 36 years were identified by reviewing the osteomyelitis database of our clinic centre. The database was used to prospectively identify all osteomyelitis cases between 2013 and 2017, and all data then was retrospectively analysed. Results The mean follow-up period was 35 months (range 24–60). The aetiology was trauma in 43% (12) of the patients and haematogenous in 57% (16) of the patients, and Staphylococcus aureus was a solitary agent in 50% (14) of the patients. Host-type (Cierny’s classification) was IA in 8, IIIB in 11 and IVB in 9 patients. All patients required debridement followed by the placement of a temporary antibiotic-impregnated cement spacer (rod). Seventeen patients received a cement-coated plate for internal fixation after debridement, and 13 patients needed bone grafts when the spacer was staged removed. All patients attained an infection-free bone healing state at the final follow-up. The final average DASH (disabilities of the arm, shoulder and hand) score was 18.14 ± 5.39, while 6 patients (two developed traumatic olecranarthritis, four developed radial nerve injuries) showed the lowest levels of limb function (p = 0.000) and were unemployed. Three patients (type I; significant difference between type I versus type III and type IV patients, p < 0.05) experienced recurrence after debridement and underwent a second revision, which was not related to the bone graft (p = 0.226) or plate fixation (p = 0.050). Conclusions Humeral chronic osteomyelitis can be treated with general surgery and anti-infective therapy; medullary (type I) infection presents a challenge, and the antibiotic-coated cement plate provides favourable fixation without increasing recurrence of infections. Clinicians should be aware of potential iatrogenic nerve injuries when treating these patients with complicated cases, and an experienced surgeon may improve the outcome.
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Affiliation(s)
- Hongri Wu
- 1Department of Social Medicine and Health Service Management, Third Military Medical University, 400038 Chongqing, People's Republic of China
| | - Shengpeng Yu
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, 400038 People's Republic of China
| | - Jingshu Fu
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, 400038 People's Republic of China
| | - Dong Sun
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, 400038 People's Republic of China
| | - Shulin Wang
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, 400038 People's Republic of China
| | - Zhao Xie
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, 400038 People's Republic of China
| | - Yungui Wang
- 1Department of Social Medicine and Health Service Management, Third Military Medical University, 400038 Chongqing, People's Republic of China
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Concannon A, Reed P, Ostring G. Incidence, Clinical Manifestations, and Severity of Juvenile Idiopathic Arthritis Among Maori and Pacific Island Children. Arthritis Care Res (Hoboken) 2019; 71:1270-1275. [DOI: 10.1002/acr.23757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 09/11/2018] [Indexed: 11/11/2022]
Affiliation(s)
| | - Peter Reed
- Children’s Research Centre Starship Hospital Auckland New Zealand
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Woo T, Lalam R, Cassar-Pullicino V, Degrieck B, Verstraete K, Donati DM, Guglielmi G, Vanel D, Bazzocchi A. Imaging of Upper Limb Tumors and Tumorlike Pathology. Radiol Clin North Am 2019; 57:1035-1050. [PMID: 31351534 DOI: 10.1016/j.rcl.2019.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Bone and soft tissue sarcomas are uncommon tumors that can occur within the upper extremity as well as elsewhere within the body. However, certain histopathological subtypes have increased affinity for the upper limb and even certain sites within the arm and hand. Other benign masses and tumor mimics, such as infection and traumatic lesions, are more common and imaging appearances can sometimes overlap with malignant lesions making diagnosis difficult. In this article, we explore the current options for imaging of these lesions as well as typical imaging appearances of the more common upper limb tumors.
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Affiliation(s)
- Timothy Woo
- Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK
| | - Radhesh Lalam
- Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK.
| | - Victor Cassar-Pullicino
- Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK
| | - Bert Degrieck
- Department of Radiology, Ghent University UZ-Gent, MR -1 K12, C. Heymanslaan 10, Gent B-9000, Belgium
| | - Koenraad Verstraete
- Department of Radiology, Ghent University UZ-Gent, MR -1 K12, C. Heymanslaan 10, Gent B-9000, Belgium
| | - Davide Maria Donati
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna 40136, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Via U. Foscolo 7, Bologna 40123, Italy
| | - Giuseppe Guglielmi
- Department of Radiology, University of Foggia, Viale Luigi Pinto 1, Foggia 71100, Italy
| | - Daniel Vanel
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, Bologna 40136, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, Bologna 40136, Italy
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Treatment of subperiosteal abscesses in children: is drainage of the intramedullary canal required? J Pediatr Orthop B 2017; 26:497-500. [PMID: 27941425 DOI: 10.1097/bpb.0000000000000283] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Acute osteomyelitis can be successfully treated with antibiotics alone. Surgery is utilized after failure of antibiotic treatment or if an abscess is present. Limited evidence exists with regard to whether intramedullary drainage is required in addition to the drainage of the subperiosteal abscess. We reviewed our 9-year experience of treating subperiosteal abscesses identifying 68 patients. Thirty patients underwent both intramedullary and abscess drainage, whereas 38 patients underwent drainage of the abscess alone at the initial procedure. Our analysis demonstrated a statistical significance (P=0.012) and odds ratio of 6.46 in favor of an intramedullary drainage to decrease risk for need for repeat surgical treatment.
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