Physeal change after tuberculous osteomyelitis of the long bone in children.
BACKGROUND
Tuberculous osteomyelitis of the long bone in children is often neglected, and established transphyseal bone lesions are common. The purpose of this study was to evaluate the clinical outcomes of these patients.


METHODS
Between January 1990 and December 2008, 19 patients (10 boys and 9 girls) with sustained tuberculous osteomyelitis of the long bone accompanied by physeal involvement were treated at our institute. The average age was 23.8 months (range, 10-58 months). All patients received surgical treatment and antituberculosis therapy for at least 6 months. The final radiographic and functional results were analyzed.


RESULTS
All patients were followed up for an average of 61.8 months (range, 14-123 months). The most common site of infection was the distal femur (8 patients, 42.1%), followed by the proximal tibia (5 patients, 26.3%) and the distal tibia (3 patients, 15.8%). Most of the lesions were osteolytic, round to oval in shape, and showed marginal sclerosis. Some lesions were expanding or multiloculated. The periosteal reaction was minimal. Even in cases with extensive surgical curettage through the physis, the growth plate maintained its function and gradually remodeled. Clinical symptoms improved within 4-6 weeks. All bone lesions decreased in size in 3-6 months. Further, physeal bar formation was observed, but the extent was minimal. All transphyseal lesions healed gradually over a period of several years. Good remodeling of skeletal lesions was noted.


CONCLUSIONS
The diagnosis of tuberculous osteomyelitis of the long bone should be considered in every child with unexplained chronic limb pain or swollen limbs. The lesions are usually located in the metaphysis and easily cross the growth plate to the epiphysis. Surgical debridement is beneficial in both diagnosis and treatment. In patients with growth plate involvement, careful surgical debridement is recommended to eradicate infection since the risk of permanent physeal damage is minimal. The physis can heal gradually, and full range of motion of the adjacent joints can be maintained.
Kao
Hsuan-Kai
HK
Department of Orthopedics, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Yang
Wen-E
WE
Shih
Hsin-Nung
HN
Chang
Chia-Hsieh
CH
D002675:Child, Preschool; D004838:Epiphyses / Q000473:pathology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010019:Osteomyelitis / Q000382:microbiology / Q000473:pathology*; D014394:Tuberculosis, Osteoarticular / Q000382:microbiology / Q000473:pathology*