A Novel Technique of Intramedullary Decompression by Gigli Saw-Wire Loop for Pan-Osseous Osteomyelitis in Children

Background: Pan-osseous osteomyelitis in children poses a treatment challenge. Due to the narrow medullary canals and fragile bone architecture, intramedullary decompression becomes difficult in these patients. Objective: To assess the outcomes of a novel intramedullary decompression technique using a flexible Gigli saw wire in children with pan-osseous osteomyelitis. Materials and Methods: This retrospective study included 28 children (mean age: 3.45 y; range: 9 mo to 9 y) treated between 2009 and 2023. All had MRI-confirmed pan-osseous osteomyelitis unresponsive to antibiotics. A metaphyseal window was created, through which a Gigli saw wire loop was inserted to scrape the medullary canal, followed by thorough irrigation with saline. Culture-specific antibiotic therapy started after the surgery. Patients were monitored for a minimum of 2 years. Results: The tibia was the most commonly affected bone (16/28). Twenty patients (85%) achieved complete clinical and radiologic healing within 12 weeks. Four patients required further surgical intervention for complete bone healing. One incident of wire breakage within the bone happened. It was retained without any adverse event. Conclusion: Gigli saw wire-assisted medullary decompression is a safe and effective technique for young children with pan-osseous osteomyelitis. Its flexibility and low profile allow complete intramedullary debridement with minimal risk of iatrogenic injury, especially in small bones where traditional reamers may be unsuitable.