A short case discussion on the topic chronic osteomyelitis

1. Short case
Chronic osteomyelitis
Gopisankar.M.G.

2. • 46 year old female presented with pain and
swelling Left thigh and fever for one week
• O/E Diffused circumferential swelling on the upper
third of the left thigh
• Skin over is tense , shiny edema whole over the
lower limb (L) on deep palpation

3. • No lymph node enlargement
• Feeble dorsalis pedis pulsation on Left LL
• There is circumferential length difference at the
swelling compared to the normal side about 6.5 cm
• No longitudinal length changes
• Knee joint flexion is actively and passively limited to
60 degree due to pain

4. • Attitude in supine position , whole of the leg is
rotated laterally

5. Differential diagnosis
• Chronic osteomyelitis of the upper one third of
femur
• Osteosarcoma
• Soft tissue sarcoma ( fever is against the diagnosis)
• Ewings sarcoma (but age is against)
• Metastatic bone disease but osteolytic

6. • Tubeculous osteomyelitis
• Soft tissue infection

7. Investigation
• Basic investigation
• Specific
• CRP
• Radiological investigation
• X ray
• MRI

9. 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 plane
due to inflammatory response
• Bands of radio opaque areas seen to emerge from
bone towards the muscle layer  may be fluid , pus
or blood

10. • Bone – there is thickening due to periosteal reaction
• Medulla rarefaction and body tries to contain the
infection by sclerosis
• Cortical bone continuity is lost
• Islets of medulla rarefaction due to massive sclerosis

11. • Treatment
• Surgical
• antibiotics

12. • Removal of dead bone
• Elimination of dead space

13. Procedures
• Sequestrectomy
• Saucerization
• Curettage
• Excision oa an infcted bone
• Amputation

14. Thanks