Treatment of chronic osteomyelitis in children resistant to previous therapy.

Patients admitted to the authors' institution with tibial osteomyelitis between 1978 and 1998 were reviewed. The purpose of this study was to determine the incidence, etiology, treatment, and outcome in chronic pediatric tibial osteomyelitis. The authors describe their treatment of chronic osteomyelitis in children resistant to previous therapeutic modalities. Thirty patients were identified with a mean age of 8.5 years at diagnosis. Mean age at admission was 9.6 years, indicating more than a 1-year duration of disease. Follow-up averaged 2.3 years. Patients underwent 97 procedures, averaging 3.2 procedures per patient. Hospital stay ranged from 2 weeks to 18 months, with an average stay of 4.7 months. Seventy-seven percent of patients were culture-positive, and 78% of positive cultures identified Staphylococcus aureus as the causative pathogen. Eighty percent of patients had a good outcome, 13% had a fair outcome, and there were no poor results. Patients with large tibial defects obtained good results with both tibiofibular synostosis and Ilizarov distraction osteogenesis. The authors describe the only reported group of pediatric patients successfully treated using Ilizarov bone transport for bony tibial defects due to osteomyelitis.