Bone Cutter
Chronic Om of tibia
Sunday, November 28, 2010 2:31 AM |
0 SAID SOMETHING
Presentation:
-chronic discharging pus following fracture
Examination:
-inflammed swollen leg
-area of tenderness
-sinus with discharge
-ROM of ankle and knee
-abnormal movement at fracture site
Common Qs:
-gen. examination:
-toxic
1.What is your diagnosis? Diff. for chronic discharge
-Chronic OM of tibia
-Foreign body
-fungal infection
-soft tissue tumor, eg.epithelioma
# Diff. diagnosis of inflamed /swollen leg without ulcer/sinus.
-acute OM
-cellulitis
-DVT
-ruptured Baker's cyst.
2.Investigations:
-TWDC
-ESR/CRP
-Swab/Blood C&S
-plain x-ray
3.What are the X-ray changes in Chronic OM?
-sequestrum
-involucrum
-osteolytic bony lesion/ cortical destruction
-periosteal elevation (eg. Codman's triangle)
-fracture line
4.Management:
-IV antiobiotics
-Debridement (Sequestrectomy/ drainage of abscess)
-protect the bone(back slab) - pathological #
-if fracture is present ( infected non union) - stabilize with ex. fix.
-Local wound dressing.
5.Complications of OM:
-pathological #
-septicemis
-malignant changes(epithelioma , SCC)
Labels:
Short cases in orthopaedics
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I am a lecturer and a surgeon in Orthopaedic and spine, working in School of Medical Science, USM.
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-November 2010
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