Efficacy of antibiotic-loaded calcium sulphate pellets in the surgical management of chronic hematogenous osteomyelitis in children: a retrospective comparative study

To compare the outcomes of surgical debridement vs. surgical debridement with antibiotic-loaded calcium sulphate pellets (ALCSP) insertion for chronic hematogenous osteomyelitis in children (CHOM) with reference to recurrence, healing, and complication rates. A retrospective comparative study was conducted, including children less than or equal to 16 years who underwent surgical treatment for CHOM between June 2017 and 2023. Patients underwent either surgical debridement alone or debridement with ALCSP insertion. Demographic characteristics, Beit CURE classification, microbiological profile, inflammatory markers, recurrence, healing, reoperation, and complication rates were analyzed. Continuous variables were compared using Welch's independent t-test, while categorical variables were analyzed using Fisher's exact test or the Fisher-Freeman-Halton exact test, as appropriate. Fifty-five children (55 limbs) were included, comprising 38 patients treated with debridement alone and 17 treated with debridement and ALCSP insertion. Baseline demographic characteristics and Beit CURE classification were comparable between groups. Recurrence and reoperation rates were significantly lower in the ALCSP group compared with the debridement-alone group (5.9 vs. 44.7%; P = 0.0048). Healing rates were significantly higher in the ALCSP group (94 vs. 55%; P = 0.005). Subgroup analysis demonstrated a significant reduction in recurrence among Beit CURE type B2 lesions treated with ALCSP (P = 0.03). Complication rates were significantly lower in the ALCSP group (5.9 vs. 44.7%; P = 0.005). The use of ALCSP as an adjunct to surgical debridement was associated with significantly lower recurrence, reoperation, and complication rates, together with improved healing in pediatric chronic hematogenous osteomyelitis, particularly in Beit CURE type B2 lesions.