Concluded Case

Osteomyelitis, curitage

60 years male complaint of recurrent discharging sinious tract from left proximal tibia suspected osteomyelitis on plane x ray shows sequstrum and cloica was vissible then send for mri shows cavity in side proximal tibia So now the question is how to manage.

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Concluded answer
Did exploration, curitage of whole leasion, with through wash with 6 pints of ns and betadine with peroxide wash and then filled with vancomicine and miropenamin applied locally. Applied drain and closed and send tissue for hisopatological examination and culture and sensitivity Now started injectable antibiotics.
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Need some additional information like whats the duration of the discharge or any history of trauma to differentiate between haemotogenous or exogenous. Though haemotogenous is rare in adults but it does happen. Classify according to Cierny mader classification and take a call if the patient is fit for surgery. My choice would be 2 stage Masquelet technique. First stage radical debridement +antibiotic spacer+temporary stabilisation with nail or ring fixator(since its very proximal tibia). Send tissure and bone specimen for culture and sensitivity post debridement. Antibiotic IV for 4 to 6 weeks according to culture and sensitivity report. Second stage- Repeat ESR CRP to see if there are no signs of infection . By 5 weeks induced membrane would be formed. Autograft +Allograft.Stabilise with locally antibitoc coated expert tibia nail.
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Did exploration, curitage of whole leasion, with through wash with 6 pints of ns and betadine with peroxide wash and then filled with vancomicine and miropenamin applied locally. Applied drain and closed and send tissue for hisopatological examination and culture and sensitivity Now started injectable antibiotics.
Assuming it is non traumatic Ruptured broodies abscess CT scan is more informative in this case Also do culture from sinus without contamination Send fungal culture also AFB stain and culture in rare case of tuberculus osteomyelitis CBC esr
Ok thanks for suggesting
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It looks like old injury ?skin grafting lower anterior thigh if it true need to elaborate previous history and need to post some more blood investigations also to confirm active infection and possible post previous xrays also
Thank you doctor
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OA Osteomyelitis
Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!
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It@Osteomylites age old method Sequestrectomy and Saucerization, pus for culture and sensitivity, suitable immobilisation
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Definitely osteomyelitis in proximal end of tibia Drilling& scupping is solution Culture and sensitivity
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Osteomyelitis lt proximal tibia drilling by orthopedic surgeon material for culture and sensitivity
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Surgical debridement with antibiotic laden bone cement . @Yashavardhan T M
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