Cortical bone fenestrations with continuous antibiotic irrigation to mediate hematogenous tibial osteomyelitis in children.

The objective of this study was to evaluate the results of drainage and continuous antibiotic irrigation of the medullary canal to mediate hematogenous osteomyelitis of the tibia in children. Data were analyzed from 376 patients (388 tibiae) treated from January 1982 to December 2004. The average age at the time of surgery was 5 years and 9 months. The diagnosis of mediate hematogenous osteomyelitis was based on clinical examination, plain radiographs, scintigraphy, ultrasound, and bacterial cultures. Treatment included two groups: (i) group I [from January 1981 to September 1984 in 108 patients (112 tibiae)] who were operated on according to traditional surgical procedure (pus drainage), (ii) group II [from October 1984 to December 2004 in 268 patients (276 tibiae)] who were operated on according to cortical bone fenestrations with continuous antibiotic irrigation. Postoperative antibiotic(s) with the intravenous antibiotic therapy were administered for 2 weeks and oral antibiotic therapy for 4 weeks. The total time of antibiotic therapy was 6 weeks. There were 152 (40.4%) female and 224 (59.6%) male patients. Unilateral involvement was the most common, with the left tibia affected in 119 (31.6%) patients, and the right in 245 (65.2%). Both tibiae were involved in 12 (3.2%) patients. The average age at the time of operation was 5 years 9 months (range: 22 days-13 years, 7 months). All patients were classified as having a mediate stage of osteomyelitis. We attained good results in 50.9% of the patients in the group I, fair results in 7.1%, and poor results in 42% with pathologic fracture in eight tibiae. In group II, there were good results in 77.9%, fair results in 21.4%, and poor results in 0.7% tibiae with the development of chronic osteomyelitis and without pathologic fracture. In conclusion, this technique is generally safe and effective. We suggest that similar management might also be applied for hematogenous osteomyelitis of femur and humerus.