ETIOLOGY acute hematogenous osteomyelitis subacute osteomyelitis chronic osteomyelitis.
Case report Chronic Osteomyelitis
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Transcript of 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