Chronic Osteomyelitis in Children Treated With Antibiotic-Laden Cement: A Preliminary Report

Introduction: Chronic osteomyelitis and infected non-union are relatively rare conditions in pediatric patients and are more frequently observed in the developing countries. Although relatively rare, they are challenging medical and surgical issues. The current study aimed to present a novel surgical technique used to manage three patients with chronic osteomyelitis of long bones. Case Presentation: Three skeletally immature patients with chronic osteomyelitis and infected non-union of the long bones were treated surgically from 2010 to 2013 through infected site debridement of bone and soft tissues, excision of sequestrum, irrigation and antibiotic-laden cement spacer, to fill the bone defect zone, were performed in all patients. All patients underwent magnetic resonance imaging (MRI), computed tomography (CT) scan and laboratory evaluation prior to surgery. Antibiotic regimen started empirically and was adjusted according to the culture and sensitivity results. Once inflammatory markers normalized, all patients were re-operated for cement removal, bone substitute graft and concomitant osteosynthesis of the affected bone. The three patients aged 14 (two patients) and 10 years (one patient) at the time of injury. All patients had at least two years follow-up (range 2-5). Clinical and laboratory evaluation had been normalized, bone healed and all patients had returned to daily life and sport activities. Conclusions: Surgical debridement is the standard approach to chronic osteomyelitis. Since antibiotic therapy plays an adjunctive role, it is recommended to use antibiotic-laden cement to penetrate local infection. The cement also induces membrane formation that aids bone reconstruction.