Case report Chronic Osteomyelitis

8/18/2019 Case report Chronic Osteomyelitis

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IDENTITY•

Name : Mr S• Age : 24 years old

• Sex : Female

• Date of Admission : February 2 t 2!"#


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$IST%&Y TA'IN(Chief Complain : )ound at left tig

History of Illness :• Su*ered sin+e "! years ago and te ,ound did

ealed +om-letely. Te ,ound se+rete -us danare smelly

• /atient as istory of u-s and do,n fe0er and-ain at te ,ound region for te -ast "! yearsand only too1 -ara+etamol for relie0er. $istory oftenderness 3. $istory of ,armness at te siteof ,ound 3

• /atient as istory of undergoing treatment at/ale,ali $os-ital but te ,ound did not ealed.

Ten te -atient is referred to5ni0ersitas$asanuddin $os-ital

• No istory of of DM 6 y-ertension and


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(ENE&A7 STAT5S

8ons+ious6 )ell9nourised

/ : ""!;

$& : #6<o

8


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LOCAL STATUS

7eft 7eg &egion

7oo1 )ound on te medial as-e+t ,it sixe

2x2+m. )ound on te lateral as-e+t ,itsi?e "x"+m6 Dis+arge 3 deformity 96s+ar 36 s,elling 96 ematoma 9 Tearea around te ,ound is more dar1er

ten te oter area.Feel Tenderness 3

Mo0e A+ti0e and -asi0e mo0ement of i- @oint,itin normal limit

A+ti0e and -assi0e mo0ement left 1nee @oint 6 exion and extension !°- 90°

NBD •Sensibility is good•

/ulsation of te dorsalis -edis and tibialis-osterior are -al-able.


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&ADI%7%(I8 FINDIN(

Tibia Sinistra A/;7ateral

7A%&AT%&Y


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7A%&AT%&Y

FINDIN(S)8 6> 46!!9"!6!&8 46 46!!96!

$( "26 "26!9"#6!

7ED ">;>4 C"!

/7T >4 "!94!!

8T < 49"!

T 2 "9G

$sAg Non

&ea+ti0e

Non

&ea+ti0e


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&ES5ME• A > years old man admitted to te )aidin Sudirousodo

$os-ital ,it +ief +om-lain of o-en ,ound at left leg6 su*eredsin+e # monts ago and ,orsen tis -ast 2 monts. /atient asistory of trauma and undergo surgery for external Hxation onSe-tember 2!". After dis+arge6 -atient ne0er +ame ba+1 for

medi+al +e+1 u- and ,ound +are. /atient as a istory of u-sand do,n fe0er and -ain at te ,ound region for -ass 2 montbut only too1 -ara+etamol for relie0er. $istory of tenderness 3

• %n -ysi+al examination Hndings tere is external Hxationatta+ed and from anterior as-e+t tere is o-en ,ound si?e "+mx >+m x"+m at ";> middle tibia6 area around te ,ound is dar1ertan surrounding area. Ex-osed tibial bone 36 dis+arge 36and mo0ement of exion extension of 1nee is !°- 90°

• From radiologi+ Hnding tere is external Hxation atta+ed6 signs ofosteomilitis at left tibial bone.


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DIA(N%SIS8roni+ osteomyelitis left tibia


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T&EATMENT

• IBFD &7 2!T/M

• 8efa?oline "gram;"2@am;intra0enous

•

/lanning for debridement6seuestre+tomy and drainage

• a+teriology +ulture and sensiti0itytest


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DIS85SSI%N


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INT&%D58TI%N

• Osteomyelitis is an acute orchronic inammatory process ofthe bone and its stru+tures

se+ondary to infe+tion.

• )en bone infe+tion -ersists formonts6 te resulting infe+tion is

referred to as +roni+ osteomyelitis


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A--leyJs system of orto-aedi+s and fra+tures6 t ED.


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ETI%7%(Y

• /osttraumati+ osteomyelitis a++ountsfor as many as 4GK of +ases ofosteomyelitis.

• %ter ma@or +auses of osteomyelitisin+lude 0as+ular insuL+ien+y mostlyo++urring in -ersons ,it diabetes

>4K• ematogenous seeding "K.


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ST58T5&E %F %NE


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EBIDAN8E 7EADIN( T%

DIA(N%SIS


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•

%-en ,ound ,it-us sin+e#monts

• $istory of trauma3

• $istory of fe0er3 $IST%&Y

TA'IN(

• %-en ,ound 3• Tenderness 3• Ex-ose tibia

bone 3

/$YSI8A7E=AMINATI

%N • Ele0ated ES&

7A%&AT%& Y


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&ADI%7%(Y FINDIN(


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8$&%NI8%STE%MYE7ITIS

&ADI%7%(YFINDIN( 37A%&AT%& Y FINDIN(S

/$YSI8A7E=AMINATI

%N

$IST%&Y TA'IN(


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/AT$%/$YSI%7%(Y


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87INI8A7 MANIFESTATI%N


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&ADI%7%(Y


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T&EATMENT

The principles of treatment are:

• to -ro0ide analgesia and general su--orti0e

measures

• to rest te a*e+ted -art

• to identify te infe+ting organism and administere*e+ti0e antibioti+ treatment or +emotera-y

• to release -us as soon as it is dete+ted

• to stabili?e te bone if it as fra+tured

• to eradi+ate a0as+ular and ne+roti+ tissue

• to restore +ontinuity if tere is a ga- in te bone

• to maintain soft9tissue and s1in +o0er.


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ANTII%TI8S :• to su--ress te infe+tion and -re0ent its s-read

to ealty bone and to +ontrol a+ute ares.

• Te +oi+e of antibioti+ de-ends on

mi+robiologi+al studies6 but te drug must be+a-able of -enetrating s+leroti+ bone and

sould be non9toxi+ ,it long9term use.

• administered for 4# ,ee1s starting from te

beginning of treatment or te last debridementbefore +onsidering o-erati0e treatment.


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%/E&ATIBE

". DE&IDEMENT :

•. At o-eration all infe+ted soft tissue anddead or de0itali?ed bone6 as ,ell as

any infe+ted im-lant6 must be ex+ised.

•. After tree or four days te ,ound isins-e+ted and if tere are rene,ed

signs of tissue deat te debridementmay a0e to be re-eated se0eraltimes if ne+essary.


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2. D&AINA(E :

• If -us is found and released tere is little tobe gained by drilling into te medullary +a0ity.If tere is no ob0ious abs+ess6 it is reasonableto drill a fe, oles into te bone in 0ariousdire+tions.

• If tere is an extensi0e intramedullary abs+ess6

drainage +an be better a+ie0ed by +utting asmall ,indo, in te +ortex. Te ,ound is+losed ,itout a drain and te s-lint ortra+tion is rea--lied


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>. S%FT TISS5E 8%BE&

• Te bone must be adeuately+o0ered ,it s1in. For small defe+tss-litti+1ness s1in grafts may suL+e

• for larger ,ounds lo+almus+ulo+utaneous a-s6 or free0as+ulari?ed a-s6 are needed.


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AFTE& 8A&E

• %n+e te signs of infe+tion subside6mo0ements are allo,ed 9 ,al1 ,itte aid of +rut+es. Full

,eigtbearing is usually -ossibleafter >4 ,ee1s.

• 7o+al trauma must be a0oided and

any re+urren+e of sym-toms6o,e0er sligt6 sould be ta1enseriously and in0estigated.


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8%M/7I8ATI%N

• %steone+rosis

• Artritis se-ti+

•

S1in +an+er suamous +ar+inoma


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/&%(N%SIS

OStagingJ te +ondition el-s in ris1beneHt assessment and as some -redi+ti0e0alue +on+erning te out+ome of treatment. Te system -o-ulari?ed by 8ierny etal. 2!!> is based on bot te lo+al -atologi+al anatomy and te ostba+1ground Table 2.2.


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T$AN' Y%5

Documents

Case report Chronic Osteomyelitis