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Background: Large skeletal defects due to postosteomyelitis are uncommon, and they present a challenging reconstructive problem. The aim of our study was to summarize our experience performing a distraction osteogenesis technique using an intramedullary nail and a monolateral external fixator in the reconstruction of massive postosteomyelitis skeletal defects of the femur. Methods: Between January 1998 and October 2004, 17 patients with massive postosteomyelitis skeletal defects of the femur (11 men and 6 women), underwent the reconstruction procedure. After osteotomy of diaphysis of the femur, we inserted an intramedullary nail into the femur, and we placed a monolateral external fixator with half-pins lateral to the nail. Lengthening was started on the seventh postoperative day at a rate of 1 mm/d. Once we achieved solid bone union, we removed the monolateral external fixator; the intramedullary nail remained for bone consolidation until reconstruction was complete. We assessed the outcomes clinically and radiographically at a mean of 70.3 months postoperatively. Results: At follow-up (mean 70.3, range 14.0-96.0 mo), all the skeletal defects were filled, bone union at docking sites was achieved without bone graft and leg length discrepancies were less than 2.5 cm in all patients. The mean gain in length was 12.9 (range 10.2-18.4) cm. According to Paley and Maar's evaluation criteria, we graded the bone results as excellent for 10 patients, good for 5, fair for 1 and poor for 1. We graded the functional results as excellent for 12 patients, good for 4 and fair for 1. The mean external fixator index was 18.1 d/cm; the consolidation index was 35.7 d/cm. Ten patients experienced pin infection, and 1 patient experienced a recurrence of deep infection. There were no neurologic or vascular injuries. Conclusion: Our study demonstrates that a distraction osteogenesis technique using an intramedullary nail and a monolateral external fixator is a reliable method for the reconstruction of massive postosteomyelitis skeletal defects. Contexte : Les lacunes osseuses majeures consecutives a une osteomyelite sont rares et causent des problemes de reconstruction difficiles. Notre etude visait a resumer notre experience d'une technique d'osteogenese par distraction utilisant un clou intramedullaire et un fixateur externe monolateral pour reconstruire des lacunes osseuses massives du femur consecutives a une osteomyelite. Methodes : Entre janvier 1998 et octobre 2004, 17 patients ayant des lacunes osseuses massives du femur consecutives a une osteomyelite (11 hommes et 6 femmes) ont subi une intervention de reconstruction. Apres une osteotomie de la diaphyse du femur, nous avons introduit un clou intramedullaire dans le femur et mis en place un fixateur externe monolateral avec des demi-broches posees lateralement au clou. On a commence l'allongement le septieme jour apres l'intervention a raison de 1 mm/j. Apres la fusion solide de l'os, nous avons enleve le fixateur externe monolateral. Le clou intramedullaire est demeure en place pour la consolidation de l'os jusqu'a ce que la reconstruction soit terminee. Nous avons evalue les resultats par des examens cliniques et radiographiques 70,3 mois en moyenne apres l'intervention. Resultats : Au suivi (moyenne de 70,3, intervalle de 14,0 a 96,0 mois), toutes les lacunes osseuses etaient comblees, la fusion de l'os au site d'amarrage s'etait produite sans greffe osseuse et la difference au niveau de la longueur des jambes etait inferieure a 2,5 cm chez tous les patients. L'allongement moyen s'est etabli a 12,9 (intervalle de 10,2 a 18,4) cm. Selon les criteres d'evaluation de Paley et Maar, nous avons juge les resultats osseux excellents chez 10 patients, bons chez 5, moyens chez 1 et mediocres chez 1 autre. Nous avons juge les resultats fonctionnels excellents chez 12 patients, bons chez 4 et moyens chez 1. L'indice moyen du fixateur externe etait de 18,1 j/cm, l'indice de consolidation s'est etabli a 35,7 j/cm. Dix patients ont eu une infection aux broches et un patient a ete atteint d'une infection profonde repetitive. Il n'y a pas eu de traumatisme neurologique ou vasculaire. Conclusion : Notre etude demontre qu'une technique d'osteogenese par distraction utilisant un clou intramedulaire et un fixateur externe monolateral constitue une methode fiable de reconstruction de lacunes osseuses massives consecutives a une osteomyelite., Hematogeneous osteomyelitis is rarely seen in the femur; however, it may lead to poor outcomes owing to delayed or inappropriate treatments, especially in developing countries. Some severe chronic osteomyelitis may [...]

A study to determine the accuracy of historical features, physical examination, and laboratory and basic radiographic testing for osteomyelitis in diabetic patients is conducted. Findings show no single historical feature or physical examination reliably excludes osteomyelitis with the diagnostic utility of a combination of findings unknown.

OBJECTIVE. To determine the complications and risk factors for complications associated with using central venous catheters (CVCs) for the treatment of acute hematogenous osteomyelitis (AHO). METHODS. We conducted a retrospective cohort study of all patients admitted to the Children's Hospital of Philadelphia between January 1, 2000, and December 31, 2003, with a diagnosis of AHO. RESULTS. Eighty patients with AHO met inclusion criteria. The median age was 5 years, and 66% of the patients were male. The most commonly affected bones were the femur (25%), tibia (20%), and pelvis (16%). Staphylococcus aureus was the most common organism identified from cultures of bone (67%) and blood (30%). Seventy-five patients (94%) received >2 weeks of intravenous (IV) antibiotic therapy via a CVC and 5 (6%) received <2 weeks of IV antibiotic therapy before conversion to oral therapy for a median of 25 days. None of the patients who switched to oral therapy within 2 weeks was rehospitalized or returned to the emergency department. Of the 75 patients who received >2 weeks of IV therapy, 41% had [greater than or equal to] 1 CVC-associated complication. Seventeen patients (23 %) had a CVC malfunction or displacement, 8 (11%) had a catheter-associated bloodstream infection, 8 (11%) had fever with negative blood culture results, and 4 (5%) had a local skin infection at the site of catheter insertion. Older age was protective against the development of a CVC-associated complication, whereas the lowest median household income was associated with development of a CVC-associated complication. CONCLUSIONS. Interventions to reduce CVC-associated complications should be developed and evaluated, particularly for young children and those from families with low household incomes. Clinical trials are needed to evaluate the safety and efficacy of oral antibiotic therapy after a short course of IV therapy as an alternative to prolonged IV therapy. Key Words osteomyelitis, central venous catheters, treatment, antibiotic use, pediatric Abbreviations AHO--acute hematogenous osteomyelitis IV--intravenous CVC--central venous catheter IQR--interquartile range CHOP--Children's Hospital of Philadelphia ED--emergency department PICC--peripherally inserted central catheter OPAT--outpatient parenteral antibiotic Therapy, EACH YEAR IN the United States, 1 of 5000 children A common approach to the treatment of AHO has consisted of several days of antibiotic administration through peripheral intravenous (IV) […]