Differentiated approach to the treatment of patients with consequences of multiple localization hematogenic osteomyelitis (Clinical observation)

Abstract

BACKGROUND: Disseminated osteomyelitis in children leads to the demise of many joints. Osteolysis of the head and femoral neck leads to the complete degradation of the hip joint, while the possibilities of organ-preserving disorders are extremely rare. Damage to the epiphyseal zone during growth causes deformation and dysfunction of the joints of other segments, which requires staged treatment. CLINICAL CASE: We presented the case of a patient with multiple consequences of epiphyseal osteomyelitis with pathological dislocation of the hips as a result of osteolysis of the heads and necks of the femur. Arthroplasty was performed successively at the age of 7 and 8 using demineralized bone and cartilage allografts according to the method stipulated by the Institute G.I. Turner with shortening osteotomies of the hips. At the age of 13, lengthening of the left femur was performed with correction of the axis of the affected segment of the lower limb. DISCUSSION: Many authors refrain from or do not have the opportunity to use organ-preserving surgical aids, relying on early endoprosthetics for pathological dislocations. However, the lifespan of a joint and endoprosthesis makes it necessary to look for ways to extend the functional suitability of musculoskeletal system, especially during the growth phase of a child. In our opinion, the use of organ-preserving interventions at the level of the hip and other segments in children with the consequences of osteomyelitis is recommended. The possibility of elongation at the level of segments, where arthroplasty was performed was earlier with preservation of ones own tissues. Correction of the axis and alignment of the length of the limbs can be effectively carried out on previously operated segments subject to certain technical features. CONCLUSIONS: Bilateral arthroplasty of the proximal femur with demineralized cartilage allografts in osteomyelitis is a completely acceptable option for organ-preserving interventions. It is possible to effectively lengthen and correct the previously operated femur while maintaining good limb function. Ultimately, the expediency, the nature of surgical interventions, and the choice of a segment for correction in such patients are determined by the characteristics of the functional adaptation of the affected segment(s).