Department of pediatric orthopedics, Jules-Verne university of Picardie and Amiens Picardie university medical center, 80054 Amiens cedex 1, France.
Department of infectious disease, Jules-Verne university of Picardie and Amiens Picardie university medical center, 80054 Amiens cedex 1, France; AGIR group, microbiology research unit, EA4294, Jules-Verne university of Picardie, 80054 Amiens cedex 1, France.
Arch Pediatr. 2020 Nov;27(8):464-468. doi: 10.1016/j.arcped.2020.08.005. Epub 2020 Oct 1.
The foot and ankle are uncommon sites of bone and joint infections (BJIs) in children. The objectives of the present study were to determine the clinical and bacteriologic features of BJIs and to assess any associated complications and orthopedic sequelae.
We performed a retrospective, single-center study of children treated for foot or ankle BJIs between 2008 and 2018 in a French university medical center. A total of 23 children were included. The median age at diagnosis was 9.1 years. Osteomyelitis was noted in 14 cases; it involved the calcaneus in seven cases, the distal fibula in four cases, the first metatarsal in two cases, and the distal tibia in one case. Arthritis affected the ankle in six cases and the cuneiform-cuboidal joint in one case. In two cases, osteoarthritis of the ankle was associated with distal osteomyelitis of the tibia. Clinical, radiological, and bacteriological parameters, surgical procedures, complications, and sequelae were recorded and analyzed.
The median (range) time to diagnosis was 3.18 days (0-10), and trauma was reported in four cases. Fever was present on admission in 18 cases, and the serum C-reactive protein level was elevated in 22 cases. Standard X-rays showed osteolysis in one case and bone sequestration in another. Staphylococcusaureus was identified in 10 cases. Surgery was performed in 17 cases. A subperiosteal abscess that required surgical drainage complicated 10 cases of osteomyelitis. No recurrence was observed. At the last follow-up, the median (range) age was 11.9 years (1.5-19). Sequelae (spontaneous tibia-talus fusion, first metatarsal epiphysis fusion, and varus deformity of the hindfoot) were observed in three cases, all of which were initially complicated by an abscess.
Physicians should be aware that pediatric BJIs of the lower limb may involve the foot and ankle. S. aureus is frequently involved. In cases of osteomyelitis, complications are closely associated with subperiosteal abscesses justifying an early diagnosis. These BJIs must be treated rapidly, and the risk of sequelae justifies long-term follow-up.
足部和踝关节是儿童骨骼关节感染（BJI）少见的发病部位。本研究的目的是确定儿童 BJI 的临床和细菌学特征，并评估任何相关的并发症和骨科后遗症。
我们对 2008 年至 2018 年期间在法国一所大学医学中心接受足部或踝关节 BJI 治疗的儿童进行了回顾性单中心研究。共纳入 23 例儿童。诊断时的中位年龄为 9.1 岁。14 例存在骨髓炎，其中 7 例跟骨受累，4 例腓骨远端受累，2 例第一跖骨受累，1 例胫骨远端受累。6 例踝关节受累，1 例跗骨-楔骨关节受累。2 例踝关节骨关节炎合并胫骨远端骨髓炎。记录并分析了临床、放射学和细菌学参数、手术过程、并发症和后遗症。
中位（范围）诊断时间为 3.18 天（0-10），4 例有外伤史。18 例入院时发热，22 例血清 C 反应蛋白升高。标准 X 线显示 1 例溶骨性病变，另 1 例骨块游离。10 例分离出金黄色葡萄球菌。17 例行手术治疗。10 例骨髓炎合并需要手术引流的骨膜下脓肿。无复发。末次随访时，中位（范围）年龄为 11.9 岁（1.5-19）。3 例出现后遗症（自发性胫距融合、第一跖骨骨骺融合和后足内翻畸形），均最初合并脓肿。
医生应认识到下肢儿童 BJI 可累及足部和踝关节，金黄色葡萄球菌常受累。骨髓炎的并发症与骨膜下脓肿密切相关，需要早期诊断。这些 BJI 必须迅速治疗，后遗症的风险需要长期随访。
