CASE REPORT ON osteomyelitis. Osteomyelitis (Femur debridement & Bone cement Spacer with External fixator). Femur Deridement- Doctors may recommend a procedure called debridement to remove dead or damaged bone tissue in people with osteomyelitis. During this procedure, the doctor cuts away dead or damaged bone tissue. He or she also washes the wound to remove any dead or loose tissue. Osteomyelitis: Osteomyelitis is an infection in a bone. Infections can reach a bone by traveling through the bloodstream or spreading from nearby tissue. Infections can also begin in the bone itself if an injury exposes the bone to germs.

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2. Femur Deridement:
 Doctors may recommend a procedure called
debridement to remove dead or damaged bone
tissue in people with osteomyelitis. During this
procedure, the doctor cuts away dead or
damaged bone tissue. He or she also washes the
wound to remove any dead or loose tissue.
 Osteomyelitis: Osteomyelitis is an infection in a
bone. Infections can reach a bone by traveling
through the bloodstream or spreading from
nearby tissue. Infections can also begin in the
bone itself if an injury exposes the bone to germs.
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3. Osteomyelitis:
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Example of Femoral spacer:

5. jess external fixator:
JESS frame provides adequate fixation of fracture in short operative time with
no further damage to soft tissue and requires only basic instruments for surgery

6. pathophysiology-osteomyelitis:
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7. HOW WOULD YOU KNOW if
SOMEONE is HAVING aN
Osteomyelitis or need femur
debridement?
• Open wound that may show pus.
• Pain at the site of infection.
• Excessive sweating.
• Fever and chills.
• General discomfort, uneasiness, or ill feeling (malaise).
• Local swelling, redness, and warmth.
• Bone pain.
• In adults, osteomyelitis most often affects
the vertebrae of the spine and/or the hips
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8. DIAGNOSTIC EXAMINATION
• X-ray at the inflammation region
• CT SCAN.
• MRI (MRI has the highest accuracy to
detect osteomyelitis with a sensitivity of
90%)
• Tissue biopsy.
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9. Ideal therapeutic approach
 The most common treatments for osteomyelitis is
surgery to remove portions of bone that are infected
or dead, followed by intravenous antibiotics given in
the hospital.
Surgery
 Drain the infected area.
 Remove diseased bone and tissue.
 Restore blood flow to the bone.
 Remove any foreign objects.
 Amputate the limb.

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10. How is osteomyelitis treated
without surgery?
 You'll usually take antibiotics for 4 to 6
weeks.
 If you have a severe infection, the course
may last up to 12 weeks. It's important to
finish a course of antibiotics even if you
start to feel better.
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11. Non-pharmacological interventions
 Hyperbaric oxygen therapy has also been proven effective in some
cases of osteomyelitis for four to 12 weeks at five days a week.
 (Hyperbaric oxygen therapy involves breathing pure oxygen in a
pressurized environment.)
 The primary care provider and nutritionist can complement the
healing process by focusing on improving comorbidities such as
anemia, diabetes mellitus and poor nutrition.
 There are some alternative methods used to treat osteomyelitis:
 While there are no herbs that specifically treat osteomyelitis, these
herbs may help strengthen your immune system and reduce
infection:
1. Garlic (Allium sativum).
2. Siberian ginseng ,etc.
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13. SUBJECTIVE DATA
 NAME: XYZ
 AGE: 13yrs
 SEX: MALE
 DEPARTMENT: Orthopaedic ward
 DATE OF ADMISSION: 12/10/2022
 DATE OF DISCHARGE: 18/10/2022

14. OBJECTIVE DATA
 COMPLAINTS ON ADMISSION:
• Pain and inflammation in left thigh (femoral bone): since 2
months
 & Pus discharge.
 History of present illness :
• Around 5 months back , fallen from tree and got a femoral
fracture.
• Then he went to the local hospital and they perform surgery
to fix it.
• Around 10-15 days after surgery inflammation occurs at the
operative area.
• 1 month later internal swelling and pus discharge started.
 PAST MEDICATION HISTORY: Not available.

15. VITAL SIGNS:
 BP: 120/81 mmHg
 PULSE : 72 beats/min
RR: 20/min
 Temp: 38.1 °C
LABORATORY INVESIGATIONS:
Blood test:
 HB: 10.1 (13-18 mg/dl )
TLC: 8650(4000-11000 cumm)
Neutrophils: 54.8(45-75%)
Lymphocytes: 34.3(20-45%)
Monocytes:
TRBC: 4.66(3.5-5.5mill./cumm)
PCV: 32.6(32-45%)
MCV: 69.9(78-98FL)
MCH: 21.7(27-32pg)
MCHC: 31.1(30-35gm%)
Platelet count: 4.02(1.5-4.5lacs/cumm)

16. Liver function test
 Serum bilirubin(total): 0.5 (0.2-1.2 mg/dl)
 Serum bilirubin(direct): 0.2 (0.0-0.25 mg/dl)
 Serum bilirubin(indirect): 0.30 (0.2-1.0 mg/dl)
 AST/SGOT: 14 (0-35 U/L)
 ALT/SGPT: 11 (0-35 U/L)
 Serum alkaline Phosphatase: 230 (80-290 IU/L)
 Serum total protein: 6.8 (6-8 g/dl)
 Serum albumin: 3.3 (3.5-5.2 g/dl)
 Serum globulin: 3.5 (2.3-3.6 g/dl)

17. renal function test
 S.Urea: 9 (10-50 mg/dl)
 S.Creatinine: 0.60(0.6-1.6 mg/dl)
OTHER INVESTIGATIONS:
X-Ray:
x-ray of left femur (AP & lateral)
ECG:
Normal

18. HPE(histopathological examination)
biopsy report:
 Specimen: bone tissue
 Section show fragments of lamellar bones &
Woven bones with fibroblastic proliferation
associated with few inflammatory cell infilterates.
 There is presence of mineralization in osteiod .
 (OSTEOID is the unmineralized, organic portion of
the bone matrix that forms prior to the maturation
of bone tissue)

19. ASSESSMENT
 Based on the subjective data and
objective data, the patient was
diagnosed with
Osteomyelitis
 & Femoral Debridement is required.

20. MEDICATION CHART
DRUG DOSE FREQUENCY ROUTE NO.OF
DAYS
REMARKS
T.DOLO
(Paracetamol)
500mg T.I.D P/O 2 HOLD
T.Ibugesic plus
(paracetamol &
ibuprofen)
325 & 400
mg
T.I.D P/O 2 HOLD
Amoxicillin and
potassium
clavulanate
500 & 125
mg
1-0-1 P/O 7 Day 3 to
CONTINUE
Pantop
(pantoprazole)
40mg 1-0-0 P/O 7 CONTINUE
T.Calcium & vit D3 500mg &
250 IU
0-1-0 P/O 7 CONTINUE
Aceclofenac &
paracetamol
100 mg &
325mg
1-0-1 P/O 7 From day 3
continue
Inj. ceftriaxone 500 mg 1-0-1 IV 2 HOLD
T.Ondensetron 4mg 1-0-1 P/O 6 CONTINUE

21. DISCHARGE MEDICATION
1. Amoxicillin CV (500 & 125 mg) 1-0-1
2. T.Calcium & vit D3 (500mg &250 IU) 0-1-0
3. Cap.Pantop (40mg) 1-0-0
4. T.Aceclofenac &paracetamol
 (100mg &325mg) 1-0-1
 Continue for 10 days then contact your doctor
with X Ray (AP/ lateral)
TO CONTINUE

22. DISCUSSION ON THERAPY
GENERIC
NAME
CLASS INDICATION MOA ADR
Inj.
ceftriaxone
Cephalosporin
antibiotics
to treat
bacterial
infections in
many different
parts of the
body.
works
by inhibiting
the
mucopeptide
synthesis in
the bacterial
cell wall.
nausea,
vomiting, pain
in your upper
stomach that
spreads to your
back; pale or
yellowed skin,
dark colored
urine; new or
worsening
breathing
problems .

23. GENERIC
NAME
CLASS INDICATION MOA ADR
Cap.Pantop D
PPI &
domeperidon
e is
D2 receptor
antagonist
Gastro-
esophageal
reflux disease,
Heartburn,
Esophagus
inflammation,
Stomach ulcers
Inhibit the proton
pump and
reduce the
gastric
secretions.
Loss of
balance,
Increased bone
fractures, Skin
itching,
Diarrhea.
T.Calcium &
vit D3
NA low calcium
levels such as
bone loss
(osteoporosis),
weak bones
(osteomalacia/r
ickets),
decreased
activity of the
parathyroid
gland
(hypoparathyroi
dism), and a
vitamin D is the
maintenance of
normal levels
of serum
calcium and
phosphorus
in the
bloodstream by
enhancing the
efficacy .
gas,
constipation,
bloating,
nausea/vomiti
ng, loss of
appetite,
mental/mood
changes, and
bone/muscle
pain.

24. GENERIC
NAME
CLASS INDICATION MOA ADR
T.Acceclofen
ac &
paracetamol
NSAIDs &
Antipyretic
Reduce pain
and fever
Aceclofenac
acts by
inhibiting
certain
enzymes
responsible for
the formation
of
prostaglandin,
thus helps in
relieving pain
and reduce
swelling
Dizziness.
Drowsiness.
Dyspepsia.
Abdominal
pain.
Nausea.
Diarrhoea.

25. GENERIC
NAME
CLASS INDICATION MOA ADR
T.Amoxicillin
and
potassium
clavulanate
penicillins
and beta-
lactamase
inhibitors
to treat certain
infections
caused by
bacteria,
including
infections of
the ears, lungs,
sinus, skin,
and urinary
tract
It works by
killing the
bacteria and
preventing
their growth
pain or
tenderness in
the upper
stomach, pale
stools, dark
urine, loss of
appetite,
nausea,
vomiting, or
yellow eyes or
skin
T.ONDANSE
TRON
serotonin 5-
HT3 receptor
antagonists.
to prevent
nausea and
vomiting that is
caused by
medicines
(chemotherapy
) or radiation
blocking the
action of
serotonin, a
natural
substance
that may
cause nausea
headache.
constipation.
weakness.
tiredness.
chills.
drowsiness.

26. DRUG INTERACTIONS
 No any drug interaction found.

27. PHARMACIST
INTERVENTION
Aceclofenac , paracetamol and
Serratiopeptidase combination will be
more effective in case of Aceclofenac and
pcm.
Educate patient about medication
compliance.
Provide deep venous thrombosis and
pressure sore prophylaxis.
Improve muscle strength and functioning
by normal stretching .

28. PATIENT COUNSELLING
 ABOUT DISEASE
1. If inflammation is not gradually decreasing then consult with the
doctor with X –Ray imaging.
2. Pus discharge should be stopped.
3. Maintain hygienic conditions.
4. Change and monitor your bandage properly as directed by the
doctor.
5. Assess nutritional needs and promote bed rest.
 ABOUT DRUGS
 T.Pantop D:
• It should be taken empty stomach to reduce gastric irritation.
• If you miss any drug dose continue with the next dose , do not
take more than prescribed pill at a time.
 On facing any discomfort because of the medicine talk to the
doctor.

29. LIFESTYLE MODIFICATIONS
 Do not move to much and don’t plan for travelling .
 Maintain hygienic conditions.
 Cover your wound for reducing the chance of
infection.
 Use dairy products like Milk , yogurt etc.
 Increasing your consumption of fresh fruits and
vegetables, whole grains and fish.
 Spinach may be a beneficial food in treating your
osteomyelitis, due to its high vitamin A content.
 After being recover regular exercise is essential.
Adults aged 19 to 64 should do at least 1 hours and
30 minutes of moderate-intensity aerobic activity.
 Eat fish and poultry instead of red meat . Fish
contains so called healthy fats –unsaturated fats.

30. Thank you