The Use of Antibiotic-Impregnated Cement in the Surgical Treatment of Chronic Osteomyelitis in Children

Aim: Information in the literature related to paediatric chronic osteomyelitis is extremely limited as the disease can be prevented to a large extent in developed countries. The aim of this study was to evaluate the clinical and radiological results of patients treated with two-stage surgical debridement and antibiotic-impregnated cement because of chronic osteomyelitis, and to thereby contribute to the literature. Material and Method: Two-stage surgical debridement and antibiotic-impregnated cement was performed because of chronic osteomyelitis in 8 patients (6 males, 2 females) with a mean age of 6 years (range, 2-11 years) between June 2018 and June 2022. Demographic data were recorded together with the time since the onset of symptoms, anatomic localisation, accompanying fractures, and laboratory parameters. Postoperatively, the patients were followed up in respect of infection recurrence, nephrotoxicity, and fracture healing with direct radiographs and laboratory tests. Results: The mean follow-up period was 19 months (range, 12-30 months). The localisation of chronic osteomyelitis was determined to be the femur in 2 (25%) patients, the tibia in 3 (37%), the humerus in 2 (25%), and the radius in 1 (12%). In 3 (37%) patients with no history of trauma, the diagnosis made on first evaluation was osteomyelitis-related pathological fracture. No recurrence of infection was observed in any patient during the follow-up period after the final surgery. Full bone union was observed in the cases with accompanying fracture, and of these, deformity was determined in 2 and mild contracture in 1. Conclusion: Paediatric chronic osteomyelitis can lead to severe problems of bone integrity, especially in cases which have been neglected or when presentation is delayed. Despite predictable complications, the application of antibiotic-impregnated cement may be effective in the context of providing infection eradication and bone union, which are the main treatment aims in this disease.