Pediatric Chronic Fibular Pandiaphyseal Osteomyelitis: Case Report with Literature Review

Main Article Content

Angelo Carlo M. Ostrea
Miguel David R. Ramos
Rodolfo V. Frez


Background: Chronic Osteomyelitis is a devastating infection causing severe disability in the pediatric population due to its often late presentation. Fibular osteomyelitis is relatively uncommon, with only a few documented reports worldwide.

Case Presentation: We present a case of a 9-year old male presenting with left leg pain subsequently diagnosed to have chronic pandiaphyseal osteomyelitis of the fibula, who was then treated with En bloc resection and culture guided antibiotic therapy for Methicillin-resistant Staphylococcus aureus. Full functional recovery of the left leg was noted at two weeks follow-up with normal infection markers after four weeks.

Conclusion: Diffuse osteomyelitis of long bones are a challenge to treat, as the gold standard of sequestrectomy and debridement may result to poor limb function. Chronic fibular osteomyelitis may be treated just like a tumor of the fibula, wherein en bloc resection can result to good functional outcome.

Pediatric osteomyelitis, fibula, pandiaphyseal.

Article Details

How to Cite
Ostrea, A. C. M., Ramos, M. D. R., & Frez, R. V. (2020). Pediatric Chronic Fibular Pandiaphyseal Osteomyelitis: Case Report with Literature Review. Asian Journal of Orthopaedic Research, 4(3), 18-28. Retrieved from
Case Study


Press E, Sierink JC, Schep NWL, Terra MP, Luitse JSK, Goslings JC. A case of sequester and involucrum formation of the fibula. J. Med. Cases. 2012;3(1):7–11.

Ponio S, Delos Reyes C. An epidemiologic investigation of chronic osteomyelitis among pediatric patients admitted from 2006 to 2010 at the Philippine general hospital. Pediatr. Infect. Dis. Soc. Philipp. J. 2013;14(1):14–23.

Varun V, Naveen S, Anuj R, Gaurav K, Shilpi S, Vikas V. Case report osteomyelitis of fibula in a child: A rare case report with a huge sequestrum. Sch. Acad. J. Biosci. 2015;3(6):563–566.

Castellazzi L, Mantero M, Esposito S. Update on the management of pediatric acute osteomyelitis and septic arthritis. International Journal of Molecular Sciences. 2016;17(6).

Jones HW, Beckles VLL, Akinola B, Stevenson AJ, Harrison WJ. Chronic haematogenous osteomyelitis in children: an unsolved problem. J. Bone Joint Surg. Br. 2011;93(8):1005–10.

Zaoutis T, Localio R, Leckerman K, Saddlemire S, Bertoch D. Prolonged intravenous therapy versus early transition to oral antimicrobial therapy for acute osteomyelitis in children. Pediatrics. 2009; 123(2):636–642.

Ziani F, Martini M. Results of the surgical treatment of chronic hematogenous osteomyelitis of the fibula. Int. Orthop. 1990;14(2):167–73.

Elö G, Boda A. Experience in the management of osteomyelitis of the fibula. Magy Traumatol Ortop Kezseb Plasztikai. 1994;37(2):143–150.

Tanaka M, Matsui H, Tsuji H. Atypical mycobacterium osteomyelitis of the fibula. 1993;48–50.

Panchani S, Simmons D. A rare cause of fibula osteomyelitis. Eur J Orthop Surg Traumatol. 2009;19:591–593.

Moreau P. Osteomyelitis of the fibula due to septic embolism: A rare complication of a graft-enteric erosion. J Cardiovasc Surg. 1998;39:171–3.

Percin S, Savk O, Icagasioglu D. Meningococcal osteomyelitis of the fibula. Acta Orthop. Belg. 1993;59(2):219–221.

Huang L, Wu Y, Miao X. Localized Histoplasma capsulatum osteomyelitis of the fibula in an immunocompetent teenage boy: A case report. BMC Infect. Dis. 2013; 13(1):132.

Yin P et al. Ilizarov bone transport for the treatment of fibular osteomyelitis: A report of five cases. BMC Musculoskelet. Disord. 2015;16(1):242.

Hatzenbuehler J, Pulling TJ. Diagnosis and management of osteomyelitis - American family physician. Am Fam Physician. 2011; 84(9):1027–1033.

Ratnayake K, Davis AJ, Brown L, Young TP. Pediatric acute osteomyelitis in the postvaccine, methicillin-resistant Staphylococcus aureus era. Am. J. Emerg. Med. 2015;33(10):1420–1424.

Mantero E, Carbone M, Calevo MG, Boero S. Diagnosis and treatment of pediatric chronic osteomyelitis in developing countries: Prospective study of 96 patients treated in Kenya. Musculoskelet. Surg. 2011;95(1):13–18.

Goh J, Mech A, Lee E, Ang E, Bayon P, Pho R. Biomechanical study on the load-bearing characteristics of the fibula and the effects of fibular resection. Clin Orthop Relat Res. 1992;279:223–228.