Prevalence of Complications Due to Transphyseal Hematogenous Osteomyelitis

Article Article scientifique Article Prevalence of Complications Due to Transphyseal Hematogenous Osteomyelitis eng 2024-12-27 author Cochard Blaise Damien 0000-0002-3330-935X Pediatric Orthopaedic Unit, Pediatric Surgery Service, Geneva University Hospitals, Geneva, Switzerland.,Division of Orthopaedic and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland. 920772 author Ciprani Asia Bambino Gesù Children's Hospital, Immunology and Infectious Diseases University, Rome, Italy. author Cirillo Marco 0000-0003-4279-0445 Department of Imaging, Bambino Gesù Children's Hospital, Rome, Italy. author Habre Céline 0000-0003-2853-4349 Pediatric Radiology Unit, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland. 643255 author Vazquez Oscar 0000-0002-1325-8575 Pediatric Orthopaedic Unit, Pediatric Surgery Service, Geneva University Hospitals, Geneva, Switzerland.,Division of Orthopaedic and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland. 657355 author Frizon Louise Department of Pediatrics, Children's Hospital, Geneva University Hospitals, Geneva, Switzerland. 823566 author Bracci Benedetta 0000-0002-2017-8493 Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Radiology Unit, Sant'Andrea University Hospital, Rome, Italy. author Dayer Romain Olivier Pierre 0000-0001-5439-4226 Pediatric Orthopaedic Unit, Pediatric Surgery Service, Geneva University Hospitals, Geneva, Switzerland. 502314 Département de Pédiatrie, Gynécologie et Obstétrique (PETRI) author Krzysztofiak Andrezj Bambino Gesù Children's Hospital, Immunology and Infectious Diseases University, Rome, Italy. author Ceroni Dimitri 0000-0003-4038-4881 Pediatric Orthopaedic Unit, Pediatric Surgery Service, Geneva University Hospitals, Geneva, Switzerland. 33105 Département de Pédiatrie, Gynécologie et Obstétrique (PETRI) e7 10.2106/JBJS.24.00101 39729530 0021-9355 PMC11781545 https://journals.lww.com/jbjsjournal/fulltext/2025/02050/prevalence_of_complications_due_to_transphyseal.10.aspx Background: Transphyseal hematogenous osteomyelitis (THO) is a common infectious condition, being present in 25% of patients with hematogenous osteomyelitis. A large proportion of pediatric hematogenous osteomyelitis infections can spread through the growth cartilage and therefore may be potentially responsible for growth disorders, leading to limb-length discrepancy or angular deformities. The purpose of the present study was to identify both the prevalence of complications caused by transphyseal osteomyelitis and factors influencing their occurrence. Methods: The records for all patients who had been treated for THO over a 17-year period at the University Hospitals of Geneva and the Gesù Bambino Hospital in Rome were retrospectively analyzed. Clinical, biological, and bacteriological data were analyzed. Magnetic resonance imaging (MRI) scans were reviewed for all patients to assess the cross-sectional area of growth plate involvement. Restart of growth of the affected physeal cartilage was subsequently monitored by means of iterative radiographic examination. Results: From a cohort of 594 patients with hematogenous osteomyelitis, 89 patients (15.0%) were found to have THO. The median age was 84 months (range, 1 to 167 months), with a bimodal distribution and peaks at 30 and 150 months; 59.6% (53) of the 89 patients were male. The lower limbs were most often affected, with the distal tibia and fibula accounting for 47.2% of all cases. Methicillin-sensitive Staphylococcus aureus and Kingella kingae were the most frequently identified pathogens, accounting for 61.8% of the cases. Virulence factors, such as Panton-Valentine leukocidin (PVL), toxic shock syndrome toxin (TSST), and accessory gene regulator (Agr), were recorded in 12.4% of MSSA strains. Transphyseal lesions affected a median of 7.6% (range, 0.79% to 58.2%) of the physeal surface. Complications affecting further growth were noted in 13% of patients with THO. Thrombocytopenia, leukocytosis, and the presence of virulence factors significantly influenced the occurrence of complications. Conclusions: THO affects all age categories of the pediatric population. In the present study, growth disturbance occurred in 13% of cases. The presence of deep thrombocytopenia, leukocytosis, and virulence factors, such as Agr, TSST, and PVL, seems to strongly influence the occurrence of such complications. Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. Dewey 617 Dewey 618 58 Département de pédiatrie, gynécologie et obstétrique 223 57 Département de chirurgie 222 false 546 Recherche clinique en chirurgie pédiatrique 886 Journal of bone and joint surgery. American volume 107 3 a70d8da1-ce68-4cb2-8b5c-a4fca44dbb22 Article (Published version) Public Article_scientifique_from_europePmc.pdf 1345904 application/pdf CC BY-NC-ND-4.0 687a6439b7fa934c6f18155aea0da1427599a540099966dd5dfa533564000a07 97bb541b-b87a-47cb-9d6d-ec19b21ab437 Supplemental data Public jbjs_2024_12_10_cochardsdc_24-00101.pdf 136486 application/pdf 3c0e1804854c92f203954ff5e1e275d995cda8b1ed32185bcce0414f570b7c00 openAccess Faculté de médecine / Section de médecine clinique / Département de pédiatrie, gynécologie et obstétrique Faculté de médecine / Section de médecine clinique / Département de chirurgie

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Prevalence of Complications Due to Transphyseal Hematogenous Osteomyelitis	Journal of bone and joint surgery. American volume			2024	13	161

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Frizon, Louise