Treatment of bone infections in children in low-income countries – A practical guideline based on clinical cases - University of Regensburg Publication Server

URN to cite this document:: urn:nbn:de:bvb:355-epub-549626
DOI to cite this document:: 10.5283/epub.54962

Loro, AntoniO ; Fulvio, FranceschI ; Alt, Volker

License: Creative Commons Attribution 4.0
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Date of publication of this fulltext: 03 Nov 2023 15:02

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Abstract

Abstract

In low-income countries (LIC), the management of bone infections is a huge challenge. A high number of patients
are in the pediatric age group. Children and adolescents exhibit good bone healing potential offering treatment
options that mainly rely on the biological response of the infected bone. The purpose of this article is to highlight
treatment options for these patients in LIC, which is based on clinical cases that illustrate the principles of the
treatment, focusing on bone reaction and healing potential.
First, identification of emergency cases is of importance. Sepsis of the patient due to bone infections is a lifethreatening
disease that requires immediate surgical attention with abscess incision. It should be tailored to the
surgeon’s experience and local conditions to avoid unwanted complications, such as excessive bleeding, fracture
or bone loss.
In non-septic patients, uncomplicated cases should be distinguished from complicated cases as the first might
often require only abscess incision, particularly in small children, without any other major surgical intervention.
Biomechanical stability and bone formation capacity, soft tissue conditions and joint involvement are decisive
factors differentiating uncomplicated from complicated cases. Central treatment column is the immobilization of
the infected bone with simple methods, such as plaster of Paris, braces or external fixation. This is intended to
provide sufficient stability to allow for new bone formation that subsequently downsizes the infection site and
that can bridge previously infected non-union sites or bone defects. In most cases, antibiotic treatment is not
performed as antibiotics are not available or affordable.
Severe soft tissue defects remain a major challenge as microvascular surgical experience is often required for
reliable coverage, for which referral to one of the very few specialized centers is recommended. Major bone
defects should also be treated in centers with sufficient expertise for bone reconstruction procedures. Regular
follow-ups are important to ensure healing and to avoid aggravation of the disease.
Encouraging success rates can be achieved by these treatment principles. However, it should not be forgotten
that poverty in these countries, including limited access to health care, remains one of the world’s most
important problems.

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Treatment of bone infections in children in low-income countries – A practical guideline based on clinical cases

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