Physeal Change after Tuberculous Osteomyelitis of the Long Bone in Children

Background: Tuberculous osteomyelitis of the long bone in children is often neglected,and established transphyseal bone lesions are common. The purpose of thisstudy was to evaluate the clinical outcomes of these patients.Methods: Between January 1990 and December 2008, 19 patients (10 boys and 9 girls)with sustained tuberculous osteomyelitis of the long bone accompanied byphyseal involvement were treated at our institute. The average age was 23.8months (range, 10-58 months). All patients received surgical treatment andantituberculosis therapy for at least 6 months. The final radiographic andfunctional results were analyzed.Results: All patients were followed up for an average of 61.8 months (range, 14-123months). The most common site of infection was the distal femur (8 patients,42.1%), followed by the proximal tibia (5 patients, 26.3%) and the distaltibia (3 patients, 15.8%). Most of the lesions were osteolytic, round to oval inshape, and showed marginal sclerosis. Some lesions were expanding or multiloculated.The periosteal reaction was minimal. Even in cases with extensivesurgical curettage through the physis, the growth plate maintained itsfunction and gradually remodeled. Clinical symptoms improved within 4-6weeks. All bone lesions decreased in size in 3-6 months. Further, physeal barformation was observed, but the extent was minimal. All transphyseal lesionshealed gradually over a period of several years. Good remodeling of skeletallesions was noted.Conclusions: The diagnosis of tuberculous osteomyelitis of the long bone should be consideredin every child with unexplained chronic limb pain or swollen limbs.The lesions are usually located in the metaphysis and easily cross the growthplate to the epiphysis. Surgical debridement is beneficial in both diagnosisand treatment. In patients with growth plate involvement, careful surgicaldebridement is recommended to eradicate infection since the risk of permanentphyseal damage is minimal. The physis can heal gradually, and fullrange of motion of the adjacent joints can be maintained.