A treatment strategy for complex cases of osteomyelitis in children and its applicability on three exemplary cases.

The aim of this study was to carry out a two-step surgical approach for complex cases of pediatric osteomyelitis. The surgical technique used here involved initial bone debridement and stabilization by a customized spacer (intramedullary Kirschner wires mantled with refobacin-palacosa cement). After infection eradication, the spacer was removed and distraction osteogenesis performed. This study included one boy and two girls (aged 7-10 years) with severe osteomyelitis (tibia: two, femur: one). At least 50% of the bone was initially resected, and either a bifocal physeal distraction (tibia) or callus distraction (subtrochanteric osteotomy) was performed. At discharge they were able to walk without assistance. Complete infection eradication and load restraining reconstruction was achieved in all three children.