Kitagawa Ayami, Otsuki Dai, Higuchi Chikahisa, Tamura Daisuke
Department of Rehabilitation Medicine, Osaka Women's and Children's Hospital, Izumi, JPN.
Department of Orthopedic Surgery, Osaka Women's and Children's Hospital, Izumi, JPN.
Cureus. 2025 Jun 30;17(6):e87058. doi: 10.7759/cureus.87058. eCollection 2025 Jun.
Supracondylar humerus fractures are common in children, and percutaneous pinning is the standard treatment. Infection rates are low, and osteomyelitis is rarely reported. A 4-year-old boy underwent percutaneous pinning for a supracondylar humerus fracture. Five weeks postoperatively, redness appeared at the medial pin site and that wire was removed; at six weeks the lateral site later developed granulation tissue, but no antibiotics were prescribed. At eight weeks he developed a 39°C fever. MRI on postoperative day 60 suggested osteomyelitis, and CT on day 65 demonstrated a cortical defect in the posterolateral distal humerus. Surgical debridement confirmed infection. Culture-directed therapy with intravenous cefepime plus ciprofloxacin - initiated 30 days after the first local signs and continued for five weeks - was followed by six months of oral ciprofloxacin; elbow function recovered to 0°-150° despite a residual cortical defect. This case shows that delayed antibiotics can allow a superficial pin-site infection to progress to deep osteomyelitis, and underscores that early recognition of pin-site changes with prompt antimicrobial therapy is essential to prevent deep infection and preserve function.
肱骨髁上骨折在儿童中很常见，经皮穿针固定是标准治疗方法。感染率较低，骨髓炎鲜有报道。一名4岁男孩因肱骨髁上骨折接受了经皮穿针固定术。术后5周，内侧针孔处出现红肿，遂取出钢针；6周时外侧针孔处出现肉芽组织，但未使用抗生素。8周时，他出现了39°C的发热。术后60天的MRI提示骨髓炎，65天的CT显示肱骨远端后外侧皮质缺损。手术清创证实存在感染。在首次出现局部症状30天后开始采用静脉注射头孢吡肟加环丙沙星进行针对性培养治疗，并持续5周，随后口服环丙沙星6个月；尽管存在残留皮质缺损，但肘关节功能恢复到了0°-150°。该病例表明，延迟使用抗生素会使浅表针孔感染发展为深部骨髓炎，并强调早期识别针孔变化并及时进行抗菌治疗对于预防深部感染和保留功能至关重要。
