osteomyelitis in children.neglected cases.

1. Chronic Osteomyelitis
in children

2. 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.Pt
kept in above elbow slab for 2 weeks.Pt was
asymptomatic for 1 month or so.

3. No h/o Koch / koch contact /any
major illness
No family history of Koch
Pre , Natal , Postnatal history is
normal

4. 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

5. Diagnosis
Chronic Osteomyelitis due to
I. Tuberculous origin or
II. bacterial origin or
III. both

6. 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

7. Pre op X rays

8. MRI

12. MRI REPORT

13. Treatment Plan
 Incision and excision of inflammatory collection
 Sample to be sent for
Histopathology
AFB culture

14. Operative procedure
 Anterior Elbow Approach
 Incision and excised the debris

15. Immediate Post-op X ray

16. Post op treatment
 Empirical Antibiotics Inj Augmentin and Inj Amikacin
for 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

17. AKT CAT-1
Start Ends
Intensive phase 30/04/14 30/06/14
Continuous phase 1/07/14 30/10/14

18. DOTS CARD

19. After POD 2 months X ray

20. Comparing X rays

22. Clinical Picture

24. Further Treatment
 Complete Continous phase of AKT Cat 1
 Planning for Z plasty for contracture.

25. THANK YOU