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Bioactive glass in the treatment of chronic osteomyelitis in children: Description of four consecutive cases and literature review

      Higlights

      • Chronic osteomyelitis in children is rare condition. Debridement surgery along with antibiotic therapy represent the best treatment strategy.
      • Efficient dead space management offers the opportunity to deliver antimicrobial agents directly at the infection site.
      • Bioactive glass S53P4 is a synthetic, biocompatible, degradable and osteostimulative material with angiogenic and antibacterial properties.
      • In this prospective case series bioglass was effectively used in the treatment of chronic osteomyelitis in children with a one-stage procedure. A long follow-up, up to 5 years in two cases, is documented.
      • Progressive bioglass resorption and bone remodeling was always observed and progressed through the years.

      Abstract

      Introduction

      Chronic osteomyelitis in children is a rare condition. Debridement surgery, along with appropriate antibiotic therapy, is widely agreed to represent the best procedure in the treatment of chronic osteomyelitis but can result in an extensive dead space formation. In this study, we evaluated the use of bioactive glass to address dead space management.

      Methods

      Four consecutive cases of chronic osteomyelitis treated with antibiotic therapy, one stage- surgical debridement and bioglass implantation between September 2016 and February 2017 were prospectively followed for a minimum of three years. Two cases followed acute hematogenous osteomyelitis, two cases followed fracture fixation. Clinical, histology, laboratory and radiographic findings were recorded. Primary endpoint was eradication of infection. Possible complication related to bioglass application were investigated.

      Results

      All patients achieved healing at the latest follow-up of minimum three years. No successive surgical treatments were required at any time. No complications related to the bioglass were detected. Radiographic reconstruction of normal anatomy progressed through the years.

      Conclusions

      Bioglass for the treatment of dead space after surgical debridement appears a viable option in the treatment of chronic osteomyelitis in children.

      Keywords

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