PAEDIATRIC CALCANEAL OSTEOMYELITIS

Abstract

Osteomyelitis continues to be a common problem amongst the paediatric population. Osteomyelitis of the calcaneus is an uncommon problem that still poses a problem to the treating physician. The purpose of this paper is to retrospectively review a large series of paediatric patients with calcaneal osteomyelitis. We compare our experience with that in the literature to determine any factors that may aid earlier diagnosis and or improve treatment outcomes.

A 10-year retrospective review was performed of clinical records of all cases of Paediatric calcaneal osteomyelitis managed at the two children’s orthopaedic departments in the Auckland region. The Osteomyelitis Database was used to identify all cases between 1997 and 2007, at Starship Children’s Hospital, and 1998 and 2008 at Middlemore’s Kids First Hospital.

Sixty patients fulfilled the inclusion criteria. The average duration of symptoms was 6.8 days. 40% of patients had a recent episode of trauma. 82% of patients could not weight bear on admission. Only 22% of patients had a temperature above 38 C. 27% of patients had positive blood cultures with Staph aureus being the most commonly cultured organism. X Rays, bone scans and MRI were all used to aid the diagnosis. ESR was elevated in 81% and the CRP was elevated in 77% of patients. 20% of patients had surgery with an average of 1.3 surgeries for those who progressed to surgery. Treatment length was an average of 2 weeks 6 days of oral antibiotics and 3 weeks 2 days of oral treatment. There was no post surgical complications and 10 readmissions, 3 for relapse, 3 for PICC line problems and 4 for antibiotic associated complications.

Although a sometimes more difficult diagnosis to make, calcaneal osteomyelitis can be diagnosed with an appropriate history, clinical examination and investigations. Treatment with intravenous and oral antibiotics and surgical debridement if indicated can lead to a good clinical outcome with minimal complications