Acute osteomyelitis (tibia)

Case contributed by Dr Maulik S Patel

Presentation

Fever with right leg pain, edema for the last 3 to 4 days.

Patient Data

Age: 5 years
Gender: Male
X-ray

There is no periosteal reaction/ bone lesion/ fracture/ dislocation. There is diffuse soft tissue edema involving the distal thigh and proximal leg.

Ultrasound

The popliteal vein is filled with echoes and shows poor compressibility. There is an absence of flow in the vein.

There is subperiosteal fluid with echoes involving proximal tibial diaphysis without obvious cortical erosion. There is a normal amount of anechoic fluid in the suprapatellar region.

Photo

An anteromedial proximal leg incision was made. There was pus under the thickened periosteum. Pus was drained from the subperiosteal space. Few artificial drill holes were made in the local tibial cortex. Primary suturing was not done.

Case Discussion

A child presented with fever along with right leg pain and edema. Laboratory study revealed infection. The radiograph was negative for a periosteal reaction. However, the ultrasound showed subperiosteal fluid involving the proximal tibial diaphyseal region. Surgery was done with a few hours and confirmed subperiosteal pus. A gram stain was positive for cocci.

The case shows the importance of ultrasound in the early diagnosis of acute osteomyelitis.

Surgical details and intraoperative photos courtery: operating surgeon Dr. Ritesh Patel.

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Case information

rID: 85571
Published: 2nd Jan 2021
Last edited: 3rd Jan 2021
Inclusion in quiz mode: Included

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