Hematogenous osteomyelitis of the wrist in children.
BACKGROUND
Wrist osteomyelitis is a rare infection, and few studies have been published about its prognosis and treatment.


METHODS
We retrospectively examined the medical records of 18 children older than 4 months who were diagnosed with wrist osteomyelitis. A definite diagnosis of wrist osteomyelitis required either confirmatory radiographic/bone scintigraphy changes associated with compatible clinical picture and elevated laboratory indices consistent with infection. The clinical evaluation was based on clinical and radiographic assessment at 1 week, 2 weeks, 3 months, 6 months, 1 year, and 2 years after the diagnosis.


RESULTS
Delay between initial symptoms and treatment ranged from 1 to 45 days (mean, 7 days). The radiographs at diagnosis demonstrated a lytic zone in the distal radial or ulnar metaphysis in 5 cases. All patients were treated with 6 weeks' course of antibiotics with sequential parenteral (7 days)-oral with a third-generation cephalosporin (Cefotaxim) associated with Fosfomycin. Surgical debridement was needed in 5 cases because plain radiographs, ultrasonography, or magnetic resonance imaging (MRI) had confirmed the presence of an intraosseous or subperiosteal abscess. Seven isolated organisms were methicillin-susceptible Staphylococcus aureus, and 1 was methicillin-resistant S. aureus. The average follow-up was 2 years. Significant orthopaedic sequelae as distal radius/ulna epiphysiodesis were apparent in 2 patients.


CONCLUSIONS
Wrist osteomyelitis is a severe infection with initial radiographic lytic zone in almost 30% of cases and with growth disturbance in 11% at the last follow-up. If we include the presence of intraosseous or subperiosteal abscess that required surgical debridement, the initial complication rate is 33%, which is superior to the 5% complication rate in the literature about general osteomyelitis. Misdiagnosis at initial clinical examination can explain this condition.
Fitoussi
Frank
F
Robert Debre Hospital, Paris, France. franck.fitoussi@rdb.aphp.fr
Litzelmann
Estelle
E
Ilharreborde
Brice
B
Morel
Etienne
E
Mazda
Keyvan
K
Penneçot
Georges F
GF
D000293:Adolescent; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003646:Debridement; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D016106:Methicillin Resistance; D010019:Osteomyelitis / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy*; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000628:therapy; D014955:Wrist Joint
D000890:Anti-Infective Agents