Abstract
Aims
This case series aims to describe the clinical consequences of juxta-physeal sub-acute osteomyelitis in children, specifically growth and limb deformity.
Methods
All children diagnosed with osteomyelitis between 2014 and 2016 at a single University Teaching Hospital in the UK were included. Juxta-physeal sub-acute osteomyelitis was identified using magnetic resonance imaging obtained within 48-hours of presentation. These cases were followed up prospectively on a regular basis in the outpatient clinic. Any clinical evidence of limb or growth deformity was evaluated using long-leg standing radiographs.
Results
During the study period, 63 paediatric osteomyelitis cases were identified and four of these (6%) had juxta-physeal sub-acute osteomyelitis. All bone infections were located either in the distal femur or proximal tibia. All cases were treated with six weeks of intravenous ceftriaxone and three children underwent surgical procedures. All four cases developed a growth deformity in the affected limb.
Conclusions
A variety of growth disturbances can occur following sub-acute osteomyelitis which could be secondary to physeal stimulation and overgrowth. In this series, overgrowth occurred in the physis immediately adjacent to the Brodie's abscess. Subsequently, the presence of a medial abscess caused a valgus deformity and a lateral abscess caused a varus deformity. This phenomenon has not been well-described in the literature. The tibial and femoral physes are amongst the most active in the body, which may explain the reason for the observed overgrowth deformity in these cases. The age of the patient and the method of treatment did not appear to influence the emergence of the growth deformity. None of our patients had recurrence or development of chronic osteomyelitis within the measured time period. In view of these findings, we recommend regular follow-up including assessment for limb deformity for a minimum of 3-years following the treatment of sub-acute osteomyelitis.
