title: Successful treatment of chronic osteomyelitis in children with debridement, antibiotic-laden cement spacer and bone graft substitute.
abstract: OBJECTIVE
  Chronic osteomyelitis and infected nonunion are relatively rare conditions in pediatric patients and are more frequently seen in developing countries. Although relatively rare, they are medically and surgically challenging. Here we report a novel surgical technique used to manage five patients with chronic osteomyelitis of long bones.
  
  
  METHODS
  Five skeletally immature patients with chronic osteomyelitis and infected nonunion of the long bones were treated surgically between 2010 and 2014 by a combination of resection of necrotic infected bone, debridement of surrounding soft tissue, and application of antibiotic-laden cement spacer inducing periosteal membrane before final bone reconstruction. Once inflammatory markers normalized, all the patients were re-operated for cement removal, bone graft substitution, and concomitant osteosynthesis of the affected bone, if needed. All patients underwent MRI, CT scan, and laboratory evaluation prior to surgery. The antibiotic regimen was started empirically and then adjusted according to culture and sensitivity results.
  
  
  RESULTS
  Mean patient age at the time of diagnosis was 11 years (range 4-14), and all patients had at least 2-year follow-up (range 2-5). At last follow-up, clinical and laboratory evaluation had normalized, the bone had healed, and all patients had resumed daily living and sports activities.
  
  
  CONCLUSIONS
  Surgical debridement is the standard approach to chronic osteomyelitis. Use of antibiotic-laden cement is recommended to penetrate local infection, with antibiotic therapy playing an adjunctive role. The cement also induces membrane formation that aids bone reconstruction.
  
  
  METHODS
  IV.
authors.affiliation: Pediatric Surgery Department, University Hospital Estaing, 1 Place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand, France. canavese_federico@yahoo.fr.
authors.forename: Federico
authors.initials: F
authors.lastname: Canavese
authors.affiliation: Pediatric Surgery Department, University Hospital Estaing, 1 Place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand, France.
authors.forename: Marco
authors.initials: M
authors.lastname: Corradin
authors.affiliation: Pediatric Surgery Department, University Hospital Estaing, 1 Place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand, France.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Khan
authors.affiliation: Pediatric Surgery Department, University Hospital Estaing, 1 Place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand, France.
authors.forename: Mounira
authors.initials: M
authors.lastname: Mansour
authors.affiliation: Pediatric Surgery Department, University Hospital Estaing, 1 Place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Rousset
authors.affiliation: Pediatric Surgery Department, University Hospital Estaing, 1 Place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Samba
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001843:Bone Cements / Q000627:therapeutic use*; D018786:Bone Substitutes / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D044083:Cronobacter sakazakii; D003646:Debridement / Q000379:methods*; D004756:Enterobacteriaceae Infections / Q000188:drug therapy; D005260:Female; D005599:Fractures, Ununited / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010019:Osteomyelitis / Q000188:drug therapy / Q000601:surgery*; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy; D013211:Staphylococcus aureus; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements; D018786:Bone Substitutes
keywords: Antibiotic; Cement; Children; Chronic osteomyelitis; Induced membrane