Factors associated with corticotomy in children with osteomyelitis.

BACKGROUND: This study evaluates critical associations between clinical, laboratory, and imaging findings with corticotomy status in children with osteomyelitis to learn what factors guide the decision to perform a corticotomy during surgical debridement. METHODS: A retrospective review of children (<18 years old) with osteomyelitis was performed in a single health system. Demographic data and lab values were reviewed in addition to pre-procedure contrast-enhanced MRI imaging findings to detect the presence of intraosseous abscess or necrosis and operative reports for corticotomy status. Statistical analysis was performed using Wilcoxon rank sum, Pearson's Chi-squared, and Fisher's exact test where appropriate with a p-value of <0.05 considered statistically significant. RESULTS: 124 patients with confirmed osteomyelitis were analyzed, of which 81% (100/124) underwent a corticotomy during surgical debridement. 63% (63/100) of patients who underwent corticotomy had confirmed osseous abscess or necrosis on MRI compared to only 21% (5/24) who did not (p < 0.001). Most patients who had intraosseous abscess or necrosis on contrast-enhanced MRI (93% or 63/68 patients) underwent corticotomy. Patients who underwent corticotomy were found to have a higher median age than those who did not (8.0 years versus 2.0 years respectively, p = 0.001) and those who underwent corticotomy had lower WBC counts than those who did not (9.12 cells/µL versus 11.10 cells/µL respectively, p = 0.007). CONCLUSIONS: There is a significant association between the presence of osseous abscess or necrosis on contrast-enhanced MRI and surgical corticotomies performed during debridement in pediatric patients. These findings highlight the importance of both imaging-guided diagnosis and clinical intraoperative assessment in treating pediatric osteomyelitis.