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