Osteomyelitis - femur

Case contributed by Dr Maulik S Patel

Presentation

Right femur fracture fixation about 2 years ago. Right proximal lateral thigh swelling & mild pain for the last few days.

Patient Data

Age: 55 years
Gender: Male
x_ray

Old subtrochanteric femur fracture fixation using a dynamic condylar screw. A lucency (>2 mm) around the hip screw. Thickened medial femoral cortex with a lytic area at cerclage wire level. Soft tissue thickening in the lateral thigh along the plate level.

ultrasound

The clinically visible swelling (proximal lateral thigh) is a subcutaneous collection ( about 16 ccs) with mobile internal echoes. From the subcutaneous plane, it extends to the femur cortex, screw-plate, and encircles them. Lateral craniocaudal collection extension was maximum (about 210 mm length); reaching just distal to the distal plate end. Anterior extension of about 115 mm. Medial extension about 90 mm. Posterior extension about 90 mm. The approximate volume of collection around the femur is 150 cc. The vastus intermedius muscle deeper fibers are involved in the collection.

No right hip joint effusion.

Diagram

Collection encircles the proximal femur shaft. The maximum caudal extension is on the lateral side reaching distally to the plate end.

Case Discussion

The patient presented with right proximal lateral thigh swelling, skin redness, and mild pain for the last one week. He had a right femur fracture fixation about two years ago. Ultrasound shows a proximal thigh subcutaneous abscess extending to the femur. Surgery revealed pus. Screw plates were removed. The culture report revealed pseudomonas infection.

Surgical follow-up courtesy: Operating orthopedic surgeon Dr. Apurva N. Kapadia.

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