Contemporary Surgical Management of Paediatric Chronic Osteomyelitis in Resource-Limited Settings: A Narrative Review

Abstract

John Enekele Onuminya, Dorcas Salime Onuminya and Mutaleeb Ayodele Shobode

Background: Paediatric endogenous chronic osteomyelitis is common among children in developing countries of the world with unusual outcome. The treatment of chronic osteomyelitis is difficult, but it involves a combination of antibiotic therapy, bone debridement, bone graft and soft tissue coverage. The need for surgery in the treatment of chronic osteomyelitis is well recognised, but there is no consensus on the optimal method.

Objective: This review is an update on the surgical treatment of chronic osteomyelitis.

Methods: We carried out a comprehensive review of the literature, using suitable key words such as chronic osteomyelitis, children, developing countries, surgical treatment, bone debridement, bone resection, bone graft, bone lengthening, bone transfer, muscle flap, biological therapy, recurrence, outcome on the search engines of Google scholar and PUBMED in June, 2026.

Results: The main problem with the surgical treatment of chronic osteomyelitis is recurrence. Surgical treatment options for chronic osteomyelitis range from simple saucerization, sequestrectomy, and curettage with primary or secondary wound closure (using the Papineau technique or the Lautenbach technique) to radical bone debridement with bone grafting and/or early muscle flap cover in a single stage or double stage, as in the Belfast technique (using antibiotic beads for the first 4 weeks in the first stage, followed by bone grafting and/or muscle flap cover in the second stage). In complicated cases, bone resection and lengthening with Ilizarov technique (using either magnetic lengthening nails or the Linear Ray System or an Ilizarov ring frame) or the Masquelet technique or vascularized free bone transfer or epiphysiolysis or amputation is advocated. In spite of surgical advances, the recurrent challenge remains unresolved.

Conclusions: Chronic osteomyelitis requires an interdisciplinary treatment protocol of systemic and/or local antibiotics and surgical procedures. Adjunctive biological therapy may be the panacea for recurrent infections.

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