Case Reports
Chronic Sclerosing Osteomyelitis Treated With Wide Resection and Vascularized Fibular Autograft: A Case Report
Am J Orthop. 2010 March;39(3):E28-E32
Author and Disclosure Information
Adam J. Schwartz, MD, Neil F. Jones, MD, Leanne L. Seeger, MD, Scott D. Nelson, MD, and Jeffrey J. Eckardt, MD
Dr. Schwartz is Orthopaedic Oncology Fellow, Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA and Orthopaedic Hospital, Santa Monica, California.
Dr. Jones is Professor of Orthopaedic Surgery, Professor of Plastic and Reconstructive Surgery, and Chief of Hand Surgery, University of California Irvine, Orange, California.
Dr. Seeger is Professor, Radiology, and Section Chief, Musculoskeletal Imaging, Department of Radiological Sciences, David Geffen School of Medicine at UCLA and Orthopaedic Hospital, Santa Monica, California.
Dr. Nelson is Professor, David Geffen School of Medicine at UCLA, and Chief of Pathology, Santa Monica UCLA and Orthopaedic Hospital, Santa Monica, California.
Dr. Eckardt is Professor, Orthopaedic Surgery, Chief, Section of Orthopaedic Oncology, and Helga and Walter Oppenheimer Chair of Musculoskeletal Oncology, Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA and Orthopaedic Hospital, Santa Monica, California.
Treatment recommendations for chronic culture-negative sclerosing osteomyelitis in the pediatric population have largely focused on supportive care, given the typical improvement in symptoms that occurs over time. This case report describes a patient with chronic sclerosing osteomyelitis (CSO) of the humerus who failed a prolonged course of nonoperative management. Definitive treatment consisted of resection of the diseased bone and reconstruction using a vascularized fibular osteocutaneous flap. To our knowledge, this is the first reported case of this technique being utilized specifically for CSO refractory to nonoperative management. At the time of most recent follow-up (35 months), the patient was completely pain-free and off all medication. Physical examination revealed full unrestricted passive and active range of motion. Radiographs at the time of most recent follow-up revealed intact hardware, excellent proximal and distal graft incorporation, and cortical hypertrophy. Vascularized fibular osteocutaneous flap reconstruction following resection is a viable alternative to nonoperative, expectant management for patients with refractory chronic sclerosing osteomyelitis.