Chronic Osteomyelitisin children

Clinical symptoms

Pt c/o swelling around the left since 1 month which is insidious in onset with gradually progression associated with evening rise of temperature elbow

A/h/o ?? Fall while playing 2 months back, At that time there was no significant swelling but there was pain and tenderness around left elbow.Ptkept in above elbow slab for 2 weeks.Pt was asymptomatic for 1 month or so.

No h/o Koch / koch contact /any major illness

No family history of Koch

Pre , Natal , Postnatal history is normal

On examination

General Examination : Vitals were stable. No P,I,C,C,L,E

Local Examination:

Left Elbow Swelling over the proximal forearm around 4 by 4 cm, diffuse, soft to feel

Local rise of temperature

Overlying Skin is normal and can be pinched

3 point bony relation of elbow maintained

DiagnosisChronic Osteomyelitis due to

I. Tuberculous origin or

II. bacterial origin or

III. both

Lab Investigations

Hb 11.4

TLC 9000 P54 E4 L36 M6

Platelet 4.4

ESR 51

CRP Positive 1:4

PT 14 seconds

PTT 25 seconds

Sr. Creatinine 0.5

RBS 78

Pre op X rays

MRI

MRI REPORT

Treatment Plan

Incision and excision of inflammatory collection

Sample to be sent for

Histopathology

AFB culture

Operative procedure

Anterior Elbow Approach

Incision and excised the debris

Immediate Post-op X ray

Post op treatment

Empirical Antibiotics Inj Augmentin and Inj Amikacinfor 5 days till reports

Culture report No growth

Histopathology report Tuberculous Inflammation

Montoux test 15mm induration

Started on AKT CAT 1 30/4/14 after eye examination by opthalmologist

AKT CAT-1

Start Ends

Intensive phase 30/04/14 30/06/14

Continuous phase 1/07/14 30/10/14

DOTS CARD

After POD 2 months X ray

Comparing X rays

Clinical Picture

Further Treatment

Complete Continous phase of AKT Cat 1

Planning for Z plasty for contracture.

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