Hematogenous osteomyelitis of the wrist in children.

INTRODUCTION

Wrist osteomyelitis is a rare infection, and few studies have been published about its prognosis and treatment.

METHODS

We retrospectively examined the medical records of 18 children older than 4 months who were diagnosed with wrist osteomyelitis. A definite diagnosis of wrist osteomyelitis required either confirmatory radiographic/bone scintigraphy changes associated with compatible clinical picture and elevated laboratory indices consistent with infection. The clinical evaluation was based on clinical and radiographic assessment at 1 week, 2 weeks, 3 months, 6 months, 1 year, and 2 years after the diagnosis.

RESULTS

Delay between initial symptoms and treatment ranged from 1 to 45 days (mean, 7 days). The radiographs at diagnosis demonstrated a lytic zone in the distal radial or ulnar metaphysis in 5 cases. All patients were treated with 6 weeks' course of antibiotics with sequential parenteral (7 days)-oral with a third-generation cephalosporin (Cefotaxim) associated with Fosfomycin. Surgical debridement was needed in 5 cases because plain radiographs, ultrasonography, or magnetic resonance imaging (MRI) had confirmed the presence of an intraosseous or subperiosteal abscess. Seven isolated organisms were methicillin-susceptible Staphylococcus aureus, and 1 was methicillin-resistant S. aureus. The average follow-up was 2 years. Significant orthopaedic sequelae as distal radius/ulna epiphysiodesis were apparent in 2 patients.

DISCUSSION

Wrist osteomyelitis is a severe infection with initial radiographic lytic zone in almost 30% of cases and with growth disturbance in 11% at the last follow-up. If we include the presence of intraosseous or subperiosteal abscess that required surgical debridement, the initial complication rate is 33%, which is superior to the 5% complication rate in the literature about general osteomyelitis. Misdiagnosis at initial clinical examination can explain this condition.