Abstract Supracondylar humerus fractures are among the most common elbow injuries in the pediatric population and are typically treated with closed reduction and percutaneous pinning (CRPP). While early postoperative complications such as pin tract infections and K-wire migration are relatively common, late-onset complications – particularly chronic osteomyelitis – are extremely rare, especially in the absence of early infection. We report the case of a 4-year-old boy who developed chronic osteomyelitis of the distal humerus 6 months after undergoing CRPP for a supracondylar fracture. The initial postoperative course was uneventful, with complete radiological union and full range of motion by 2 months. The child later presented with localized pain and swelling at the elbow, without systemic symptoms or movement restriction. Radiographs revealed multiple lytic lesions and a sclerotic sequestrum in the lateral condyle. Magnetic resonance imaging could not be performed due to the child’s lack of cooperation and parental refusal of sedation. Surgical debridement revealed purulent material and infected granulation tissue surrounding a sequestrum. Cultures grew Staphylococcus aureus and histopathology confirmed chronic osteomyelitis. The patient was successfully treated with targeted intravenous antibiotics, achieving full recovery without recurrence. Chronic osteomyelitis following CRPP is a rare but important complication that can occur even in the absence of early pin-site infection. Clinicians should maintain a high index of suspicion when children present with delayed pain and swelling at a previously treated fracture site. Early diagnosis and appropriate surgical and medical management are critical to preventing long-term sequelae.
Udaya et al. (Thu,) studied this question.