Cases reported "Osteomyelitis"

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1/16. Salvage of contaminated fractures of the distal humerus with thin wire external fixation.

    Fractures and osteotomies of the distal humerus that are contaminated or infected represent a difficult management problem. Stable anatomic fixation with plates and screws, the acknowledged key to a good result in the treatment of bicondylar fractures, may be unwise. A thin wire circular (Ilizarov) external fixator was used as salvage treatment in such complex situations in five patients. The fixator allowed functional mobilization of the elbow while allowing achievement of the primary goal of eradicating the infection or colonization. Two patients required a second operation for fixation of a fibrous union of the lateral condyle. One patient with a vascularized fibular graft later required triple plate fixation for malalignment at the distal host and graft junction. Four of five patients ultimately achieved complete union. The fracture remained ununited in one patient who has declined additional intervention. All five patients achieved at least 85 degrees ulnohumeral motion, two after a secondary elbow capsulectomy performed after healing was achieved. This experience suggested that the Ilizarov construct, although not a panacea, represents a reliable method of skeletal stabilization that allows functional mobilization while elimination of infection or colonization is ensured. If necessary, stiffness and incomplete healing can be addressed with an increased margin of safety at subsequent operations.
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2/16. Reconstructive surgery for a defect in the shaft of the ulna due to osteomyelitis. Long-term result of a case.

    An eight and a half-year-old boy suffered from chronic osteomyelitis of the left ulna with sinuses, destruction of the middle three-quarters with the presence of necrotic bone and posterolateral dislocation of the radial head. The operative treatment included sequestrectomy and gradual reduction of the radial head after application of an Anderson apparatus. In a second procedure a corticocancellous tibial bone graft was used to bridge the ulnar gap, and later the redislocated radial head was excised. At the latest follow-up, 45 years postoperatively, the limb is fit with normal muscle strength and very satisfactory motion of the elbow and wrist joints, and the patient works as a hard manual laborer.
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3/16. Second dorsal metacarpal artery muscle flap: an adjunct in the treatment of chronic phalangeal osteomyelitis.

    We describe a surgical approach for treating chronic osteomyelitis of the proximal phalanx in the hand. The procedure consisted of inserting the second dorsal metacarpal reverse adipofascial flap, including a small amount of interosseous muscle, into the bone marrow space of the phalanx after complete removal of the focus of infection. Two years after the procedure, the patient had full range of motion of the finger with no signs of infection or drainage. This operation resulted in minimal morbidity and a full range of motion of the finger.
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4/16. Meningococcal osteomyelitis in a premature infant.

    The authors report a rare case of acute hematogenous osteomyelitis in a premature very low-birth weight infant caused by neisseria meningitidis, a microorganism which occasionally causes arthritis, but is very rarely involved in bone infections. The strong teamwork of clinicians, the clinical microbiologist and the radiologist allowed the prompt formulation and confirmation of the clinical suspect (regardless of the paucity of symptoms and systemic signs), the rapid isolation of the microorganism and the prompt initiation of a specific therapy, thus obviating the need for a more invasive bone biopsy, which would have been hazardous considering the risks associated with an invasive procedure, and much higher in our case because of the young age of the patient and his prematurity. Moreover, this case confirms that early ultrasonographic examination may anticipate the diagnosis and the initiation of therapy in case of a clinical suspicion of acute hematogenous osteomyelitis, thus avoiding serious complications such as growth disorders or arrest, shortening or angular deformity, loss of motion and degenerative osteoarthritis. In accordance with what suggested in the literature, initial parenteral treatment followed early by oral antibiotics was chosen, with an excellent outcome.
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5/16. The use of external fixation for the treatment of spine infection with actinomyces bacillus.

    OBJECTIVE: External fixation can be used for stabilization of the spine in salvage cases, especially in cases of infection of the spine. The advantages of this method are avoiding the needs for internal fixation devices and for postoperative bracing. The literature on this is scant. Reported is a rare case of osteomyelitis of the D2 vertebra with an epidural abscess caused by actinomyces israelii that spread from the lung and was treated by decompression and external fixation. methods: A 51-year-old man with right upper lobe pneumonia due to A. israelii coccobacillus developed osteomyelitis of the D2 vertebra and an epidural abscess with a gradual paraparesis. He underwent a laminectomy of D1-D3 and 3 weeks later stabilization of the upper thoracic spine using a tubular external fixator that was inserted from C7-D1 to D3-D4. The patient was treated with antibiotic intravenously and later orally. After 2 months, the external fixator was removed. RESULTS: At the last follow-up, the patient had no fever, the erythrocyte sedimentation rate and c-reactive protein level had normal values, and there was only a slight limitation in the range of motion of the cervical paraparesis. radiography and magnetic resonance imaging demonstrated stabilization of the affected segment without any sign of active osteomyelitis. There were no complications associated with the use of the external fixator. CONCLUSIONS: The use of external fixation offers an appropriate alternative for stabilization of the spine as a salvage procedure. The procedure could be performed easily and without any major complications. Especially for the treatment of complicated cases of spinal infection, the use of an external fixator can be of great benefit.
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6/16. An unusual case of knee pain.

    osteomyelitis of the patella is a rare disease, which primarily affects the pediatric population. We present a case of hematogenous osteomyelitis of the patella with secondary development of septic arthritis of the knee. There is often a delay in diagnosis, as illustrated by our case report, due to the rarity of the condition and nonspecific presentation. There is usually no history of trauma. Focal tenderness over the patella is the most helpful clinical sign. A small joint effusion may be present which is usually sterile and reactionary due to inflammation of the patella. Treatment of osteomyelitis of the patella is similar to treatment of osteomyelitis in other areas. Function and range of motion of the knee usually returns to normal after completion of treatment. A delay in diagnosis may lead to progression of disease and complications such as septic arthritis of the knee.
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7/16. Pelvic osteomyelitis in children.

    Six children (7 to 16 years of age) with pelvic osteomyelitis are described. Sites of involvement included the pubis in three patients, the ilium in two patients, and the ischium in one patient. All were right-sided. Each patient presented with a history of fever and an abnormal gait. In four, the point tenderness indicated the site of bony involvement. All patients had pain on abduction but free passive range of motion of the hip. Soft tissue swelling was present on admission pelvic roentgenograms in five patients. Intravenous pyelogram revealed deviation of the bladder toward the midline in each of four patients studied. Roentgenographic changes typical of osteomyelitis developed in four patients ten days to ten weeks after onset of symptoms. In four patients in whom an organism was identified, staphylococcus aureus was isolated from blood and/or bone. All isolates were methicillin-sensitive and two were penicillin-sensitive. Purulent material was drained from three of the five patients who underwent surgical exploration of the pelvis. All patients received parenteral antistaphylococcal therapy for 3 to 5 1/2 weeks (mean, 4 weeks). Oral antibiotics were given to five patients for an additional 3 to 14 weeks. All patients recovered completely.
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8/16. Limb disuse in a newborn.

    osteomyelitis in the neonate is an entity distinct from that in older children. We report a case that had a benign onset, insidious course, and multiple foci of involvement. The unique metaphyseal blood supply of early infancy permitted coexisting septic arthritis. Signs of limb disuse, limitation of motion, and swelling over distal bone or joint space should prompt the emergency physician to entertain the possibility of osteomyelitis. early diagnosis and intervention on the part of the emergency physician may prevent or alleviate sequelae of this disease.
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9/16. Lunate osteomyelitis in a patient with bilateral Kienbock's disease.

    Kienbock's disease, which is osteonecrosis of the carpal lunate bone, was described by Peste in 1843 and by Kienbock in 1910. Histologic studies of affected lunate bones have revealed avascularity, osseous necrosis, fragmentation, and fibrous proliferation. The disease most often occurs between the ages of 20 to 40 years, and the onset is usually insidious. There may be a history of a single episode or repetitive trauma, although this is not the rule. The patient usually will present with pain and decreased motion of the wrist. X-ray will reveal sclerosis of the lunate of varying degrees. There are many theories of how the inciting event of avascular necrosis takes place. There are several reports in the American literature of unilateral disease complicated by osteomyelitis, but to our knowledge there are no reports of bilateral Kienbock's with one side complicated by osteomyelitis.
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10/16. osteomyelitis and septic arthritis in premature infant.

    A premature infant girl was born at 26 weeks' gestation by normal spontaneous vaginal delivery. After suffering from anemia, hyperbilirubinemia, and respiratory distress syndrome, she developed pseudomonas aeruginosa sepsis of the right knee at the age of 68 days. She was treated with daily knee aspirations, antibiotic joint instillation, and intravenous antibiotics, based on culture and sensitivity reports. Although the patient did not respond to this treatment for two weeks, surgical incision and drainage with continued intravenous antibiotics finally resulted in a complete cure of the infection and restoration of full range of motion of the knee joint.
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