Chronic Osteomyelitis

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A short case discussion on the topic chronic osteomyelitis

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Chronic Osteomyelitis

  1. 1. Short caseChronic osteomyelitisGopisankar.M.G.
  2. 2. • 46 year old female presented with pain andswelling Left thigh and fever for one week• O/E Diffused circumferential swelling on the upperthird of the left thigh• Skin over is tense , shiny edema whole over thelower limb (L) on deep palpation
  3. 3. • No lymph node enlargement• Feeble dorsalis pedis pulsation on Left LL• There is circumferential length difference at theswelling compared to the normal side about 6.5 cm• No longitudinal length changes• Knee joint flexion is actively and passively limited to60 degree due to pain
  4. 4. • Attitude in supine position , whole of the leg isrotated laterally
  5. 5. Differential diagnosis• Chronic osteomyelitis of the upper one third offemur• Osteosarcoma• Soft tissue sarcoma ( fever is against the diagnosis)• Ewings sarcoma (but age is against)• Metastatic bone disease but osteolytic
  6. 6. • Tubeculous osteomyelitis• Soft tissue infection
  7. 7. Investigation• Basic investigation• Specific• CRP• Radiological investigation• X ray• MRI
  8. 8. X ray AP and Lateral view• Left LL showing hip and knee joint is taken• Skin and subcutaneous tissue seen• There is loss of delineate of fat and muscle planedue to inflammatory response• Bands of radio opaque areas seen to emerge frombone towards the muscle layer  may be fluid , pusor blood
  9. 9. • Bone – there is thickening due to periosteal reaction• Medulla rarefaction and body tries to contain theinfection by sclerosis• Cortical bone continuity is lost• Islets of medulla rarefaction due to massive sclerosis
  10. 10. • Treatment• Surgical• antibiotics
  11. 11. • Removal of dead bone• Elimination of dead space
  12. 12. Procedures• Sequestrectomy• Saucerization• Curettage• Excision oa an infcted bone• Amputation
  13. 13. Thanks

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