Case 6

Osteomylitis of the Forearm

Case History: This 13 y.o. healthy teenager sustained a both bones (radius and ulna) forearm fracture, grade I open, playing football at summer camp. It was washed out and plated 3 days later.

Clinical Course: He developed fever, chills, and drainage of the wound several weeks after treatment. He was referred shortly after given oral antibiotics, 6 weeks after injury, with the following presentation.
Clinical Presentation:

This was the wound at presentation. Sero-purulent drainage from the mid-aspect of the wound required frequent dressing changes.
 
Pre-op X-rays:

The x-rays at presentation reveal extensive periosteal reaction along the ulna.

 
 
Surgical Exploration:
The hardware was removed. Surgical findings revealed extensive fibrinous debris, purulence, dead bone (the white sequestrum), and a shell of new bone (involucrum)--see the images we did].
 
Surgical Treatment:

Extensive debridement was carried out. Debris and dead bone were removed, and antibiotic cement beads were placed.

In this case, as in all cases of suppurative osteomyelitis, surgical debridement is primary, and antiobiotic treatment is supporitive.

This xray shows new bone formation and thus reconstitution
of the ulna where the involucrum was, at 8 weeks from the first
debridement. The dead bone that made up the sequestrum had been removed. Note the bony remodeling.

The patient underwent a six week course of antibiotics in addition to several debridement procedures.

The patient required no further treatment once the bone healed.
 
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