Factors Associated with Corticotomy in Children with Osteomyelitis

Background: Rapid non-contrast MRI is accurate in diagnosing osteomyelitis. However, prior studies demonstrate that contrast may improve osseous abscess/necrosis assessment to better guide surgical decision-making regarding sampling bone marrow. Our study aims to identify critical associations between clinical, laboratory, and imaging findings with corticotomy status to determine the ideal population for a rapid osteomyelitis MRI. Methods: A retrospective review of patients under 18 years old with osteomyelitis was conducted from two children’s hospitals. Demographic data, lab values, operative reports, the presence of intraosseous abscess/necrosis on pre-procedure contrast-enhanced MRI, and corticotomy status were reviewed. Analyses were performed using Wilcoxon rank sum test, Pearson’s Chi-squared test, and Fisher’s exact test where appropriate with a p-value < 0.05 for statistical significance. Results: 124 patients with osteomyelitis were analyzed – 81% of patients underwent a corticotomy, and 55% had osseous abscess/necrosis identified on MRI. Of those who underwent a corticotomy, 63% had MRI confirmed osseous abscess/necrosis compared to 21% who did not (p < 0.001). Further, these patients had a statistically significant higher median age and lower WBC counts than those who did not undergo corticotomy. There was no association between corticotomy status and inflammatory lab markers (ESR/CRP), anatomical location, BMI, sex, race, or ethnicity. Conclusions: Although patients with osseous abscess/necrosis on MRI were more likely to undergo bone marrow sampling, most patients analyzed still underwent corticotomy – with 81% receiving marrow sampling. Preoperative imaging plays a crucial role, but these findings highlight the importance of the clinical intraoperative assessment in surgical management of pediatric patients with osteomyelitis.