2018, Vol. 2 Issue 3, Part B
The socioeconomic status and the healthcare delivery system in developing countries has made chronic osteomyelitis as one of the pressing concerns. The main issue is the ability of microorganism to persist in minute quantity even after adequate antibiotic therapy for adequate time period. It is advised to remove the sequestrum early and let the bone heal faster but it is associated with risk pf growth plate injury as well as pathological fracture.
Materials and methods: A prospective observational study was done at All India Institute of Medical Sciences from October 2015 to October 2016. The inclusion criteria were (1) age less than 14 years (2) type 3/4 Cierny Mader chronic osteomyelitis (3) albumin level less than 4gm/dl (4) those giving informed consent. The exclusion criteria were (1) any surgical intervention prior to presentation (2) any surgical intervention in due course of treatment. Supportive treatment of vitamin C, vitamin D, Iron and Calcium supplementation was given. Serial monthly follow up was done clinically and radiologically and outcome in terms of ambulatory status was noted.
Results: 15 patients of which 10 (66.6%) were in the age group 10-14 years. Femur and humerus were commonly involved. Culture was positive in 4 cases with Staph aureus and E coli growth of2 cases each. 8 cases had discharging sinus whereas 4 of the cases had associated pathological fracture. All the patients at the end of follow up were mobilized with or without brace.
Discussion: Paediatric chronic osteomyelitis is frequently associated with diaphyseal sequestrum, which when removed, compromises mechanical stability of the bone which would entail further surgical procedure as well as a financial burden for the family. Studies show post sequestrectomy, the regenerate is formed slowly as well as of poor quality. Hence a non-aggressive conservative treatment is advised. Vitamin C, Vitamin D, Iron and calcium supplementation in malnourished children boosts up immunity as well as tissue healing through various mechanisms including effect on T and L lymphocytes, macrophages, monocytes and fibroblasts.