Nikkhahmanesh Nia, Vij Neeraj, Ranade Ashish S, Belthur Mohan
Orthopedics, University of Arizona College of Medicine, Phoenix, USA.
Orthopedics, Blooming Buds Centre for Pediatric Orthopaedics, Deenanath Mangeshkar Hospital and Research Centre, Pune, IND.
Cureus. 2023 Jul 4;15(7):e41345. doi: 10.7759/cureus.41345. eCollection 2023 Jul.
Osteomyelitis of the fibula is rare and is especially rare in children. The published literature is limited to case series and is thus lacking a comprehensive description of the disease. The purpose of this systematic review is to provide the first comprehensive summary of the demographics, presenting symptoms, laboratory values, microbiology, and treatment results of osteomyelitis of the fibula in children based on the existing literature. This institutional review board (IRB)-exempt systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) guidelines. Three search engines were used for a total of 239 studies. Twenty-six studies were screened by full text. Twelve articles underwent a quantitative analysis. Due to limited data and heterogenous reporting, the data were summarized descriptively. The methodologic quality of the studies was evaluated based on the Newcastle-Ottawa scale. The average age was 7.71±3.49 years, and males comprised 57% of the 21 cases. The most common presenting symptoms were fever (86%), antalgic gait (57%), and localized tenderness (81%). The most common site of involvement was the distal third of the fibula (90%). The average C-reactive protein (CRP) was 90.1±38.3 mg/L, and the average erythrocyte sedimentation rate (ESR) was 58.8±21.2 mm/hour. was the most cultured pathogen reported in 10/21 cases (48%). Open surgery was performed in 17/21 cases (81%), and there were no reported complications. Fever, antalgic gait, and localized tenderness should raise the index of suspicion. Prompt laboratory and radiographic evaluations can help reduce delays in diagnosis and improve outcomes. Blood and tissue cultures are currently performed in about half of the cases. Improvement in our microbiologic diagnosis has the potential to improve antibiotic selection. Local methicillin-resistant (MRSA) prevalence must be taken into consideration when starting empiric antibiotic treatment. Surgical treatment is often required with a low complication rate. The clinical and laboratory parameters identified in this study have the potential for integration into a composite clinical score.
腓骨骨髓炎较为罕见，在儿童中尤为少见。已发表的文献仅限于病例系列，因此缺乏对该疾病的全面描述。本系统评价的目的是根据现有文献，首次全面总结儿童腓骨骨髓炎的人口统计学特征、呈现的症状、实验室检查值、微生物学及治疗结果。这项获得机构审查委员会（IRB）豁免的系统评价遵循系统评价与Meta分析优先报告条目协议（PRISMA-P）指南。使用了三个搜索引擎，共检索到239项研究。通过全文筛选出26项研究。12篇文章进行了定量分析。由于数据有限且报告存在异质性，数据采用描述性总结。根据纽卡斯尔-渥太华量表评估研究的方法学质量。平均年龄为7.71±3.49岁，21例中男性占57%。最常见的呈现症状为发热（86%）、疼痛性步态（57%）和局部压痛（81%）。最常受累的部位是腓骨远端三分之一处（90%）。平均C反应蛋白（CRP）为90.1±38.3mg/L，平均红细胞沉降率（ESR）为58.8±21.2mm/小时。在21例中的10例（48%）中报告的最常培养出的病原体是[此处原文缺失病原体名称]。2例中的17例（81%）进行了开放手术，未报告有并发症。发热、疼痛性步态和局部压痛应提高怀疑指数。及时的实验室和影像学评估有助于减少诊断延迟并改善预后。目前约一半的病例进行了血液和组织培养。微生物学诊断的改善有可能改进抗生素的选择。开始经验性抗生素治疗时必须考虑当地耐甲氧西林[此处原文缺失细菌名称]（MRSA）的流行情况。通常需要进行手术治疗，并发症发生率较低。本研究中确定的临床和实验室参数有可能整合到一个综合临床评分中。
