Infectious complications in pediatric traumatology and orthopedics (analysis of clinical series)

BACKGROUND: Infectious complications in pediatric traumatology and orthopedics are relatively rare. Publications on this issue are less common than in the adult population. However, the resulting complications often lead to a persistent anatomical and functional defect, bearing the economic burden and legal consequences.

AIM: To analyze a clinical series of pediatric patients with infectious complications of injuries and surgical interventions in the skeletal system.

MATERIALS AND METHODS: A retrospective analysis of the clinical series of patients over 5 years was conducted. The study involved children aged <18 years. A sample of 34 children was included. The average age was 13.5 (min–max, 4–17 years). Patients with infectious and inflammatory complications after mechanical and/or surgical trauma, availability of a complete data archive (anamnesis, radiation therapy, and medical documentation), traced relief of inflammatory phenomena, and achievement of remission of the chronic process for more than 6 months were included.

RESULTS: Infectious complications of injuries were noted in 26 (76%) patients, complications of orthopedic interventions in 8 (24%), and open injuries in 9 (34%). The injuries were isolated in 11 (42%) children, multiple trauma in 5 (19%), and combined in 10 (39%) patients. Defects of large skeletal segments were common: the thigh in 8 (24%) patients, humerus in 5 (15%), shin in 5 (15%), and spine in 4 (12%). Five (15%) had infection of the pelvic bones, and one patient had infectious complications in the lower jaw, collarbone, elbow joint, knee joint arthritis, and foot bones. Superficial infection of the surgical intervention area was noted in 3 cases (9%), deep infection in 27 (79%), and posttraumatic osteomyelitis in 4 (12%). The average duration of the diagnostic pause was 33 days, and the therapeutic pause was 36 days. Antibacterial prophylaxis before surgery for closed injuries and orthopedic operations was carried out in only 17 patients. Bacteriological verification was not performed in 8 (23.5%) patients with complications. In 9 (26%) patients, it was not possible to identify a microbial agent in the presence of a clinical picture. The structure of pathogens correlates with the literature data on the problem in the adult population. In 10 out of 25 positive bacteriological studies, polyresistant strains were isolated. Thirty-three children underwent surgery, and the basic principle is radical surgical rehabilitation. The average number of interventions performed was 3 (min–max, 1–12). Stable relief of the infectious and inflammatory process has been achieved in all cases. The average period of inpatient treatment was 39 days, recovery was achieved in 24 (71%) children, and persistent anatomical and functional defect and disability were noted in 10 (29%) children.

CONCLUSIONS: Infectious complications in pediatric traumatology should be considered a complex multidisciplinary problem, and part of the solutions largely lies in the field of healthcare organization, specifically with an adequate choice of indications, compliance with the osteosynthesis technique, compliance with the principles of antibiotic prophylaxis, patient routine, and training of pediatric surgeons and orthopedic traumatologists on surgical infections, using modern principles and technologies for the treatment of these complications.