title: Surgical treatment of chronic osteomyelitis in children admitted from developing countries.
abstract: BACKGROUND
  The surgical management of chronic osteomyelitis in children is still challenging in developing countries. This study analysed the extent of the disease and the therapeutic regime.
  
  
  METHODS
  This was a retrospective study in two primary health care hospitals from January 2009 to December 2013, 27 children (20 males and 7 females, mean age 7 years) admitted from developing countries who were treated for chronic osteomyelitis. Localization, duration of the disease, extent of the osseous involvement, spectrum of germs, number of previous and required surgical procedures and duration of hospital stay are reported.
  
  
  RESULTS
  A total of 16 cases had haematogenous and 11 cases post-traumatic aetiology. The mean duration of the disease was 18 months. On average, three (range, 1-12) previous surgical procedures were performed. The affected bones were: Tibia in 11, femur in 8, forearm in 6 cases, spine and humerus each in 1 case. Staphylococcus aureus was the responsible germ in 75%. On average, four (range, 2-8) surgical procedures were required. Osseous stabilizations were necessary in 17, plastic soft tissue reconstructions in 8 cases. In three cases with metaphyseal/diaphyseal defect, bone transfers had to be performed (2 × fibula-pro-tibia, 1 × rib for radius). The mean hospital stay took 8 (range, 4-20) weeks. Three local recurrences occurred within 3 months, all could be cured surgically.
  
  
  CONCLUSIONS
  The surgical treatment of chronic osteomyelitis in children requires a radical osseous debridement. The knowledge of different plastic-surgical procedures is necessary to reconstruct osseous and/or soft tissue defects.
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, Verbundkrankenhaus Bernkastel-Wittlich, Wittlich, Germany.
authors.forename: Reiner
authors.initials: R
authors.lastname: Wirbel
authors.forename: Karl
authors.initials: K
authors.lastname: Hermans
mesh_terms: D000810:Angola; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003646:Debridement; D003906:Developing Countries; D004322:Drainage; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010019:Osteomyelitis / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome