Suzie Feeds the Bunny
Jennifer Fernandez
University of Saint Mary



Suzie Feeds the Bunny
Suzie was bit by a domestic pet rabbit on her index finger. Later in the
day her finger was red and swollen. When her mother asked how she hurt
herself she replied “I dunno.” Suzie’s mother then placed triple antibiotic
cream on the wound and a bandage. Suzie did not complain of pain
associated with the bite injury, and her mother did not know it was from a
rabbit bite. Four weeks later Suzie’s finger visually appeared healed,
however it was still warm to the touch with local edema and erythema.
Suzie also complained that she wasn’t able to move the index finger like her
other fingers and couldn’t hold a crayon. Suzie’s mother then brought her to
the orthopedic clinic. Suzie received an x-ray and then consequently a MRI
of both of her arms and legs.

X-ray results
On Suzie’s x-ray on the dorsal aspect of the metaphysis of the distal
phalanx there appears to be an osteolytic area. Some epiphyseal cartilage
destruction with an infused epiphysis is noted. It is difficult to assess,
however there may be the beginnings of a Brodie’s abscess. Regional
osteopenia is noted with adjacent soft tissue swelling visible. The dorsal
metaphysis appears hypo-lucent with moth-eaten or faded margins (Voit et.
Al, 2015).




Osteomyelitis can be defined as inflammation and infection in
the bone. Causes of osteomyelitis are: local areas of infection, penetrating
trauma, or infection via the blood stream that settles inside the bone
marrow. Since it appears to have affected Suzie’s metaphysis, transmission
is probably more related via the blood stream. Signs and symptoms of
osteomyelitis include fever or chills, irritability or lethargy in young
children, pain in the area of the infection, and swelling, warmth and redness
over the area of the infection. Sometimes osteomyelitis has no signs and
symptoms or has signs and symptoms that are difficult to distinguish from
other problems (Rao, Ziran, & Lipsky, 2011).

Osteomyelitis Affected Areas
Osteomyelitis typically affect the long bones, femur or humerus, in
children. In adults the vertebral bones, feet, and hips or pelvic areas are
more likely to be affected. However, since osteomyelitis can also result from
recent surgical procedures, traumatic injury, prosthetic devices, or frequent
medication injections, osteomyelitis can actually affect any bone or bone
marrow (Rao, Ziran, & Lipsky, 2011).

Prevention of Osteomyelitis
Suzie’s osteomyelitic infection could have been prevented if her
mother had brought her to the doctor after the event for prophylactic
antibiotic treatment. It is understandable for the delay in care since Suzie



was not in any distress and did not inform her mother that the injury was a
result of an animal bite. Good hygiene is a necessity to keep the wound
clean, which her mother did clean the site with soap and water and apply a
topical triple antibiotic cream and bandage. Suzie should wash her hands
several times daily with soap and water and keep the wound loosely dressed
with a gauze bandage (Rao, Ziran, & Lipsky, 2011).

Complications of Untreated Osteomyelitis
Complications of osteomyelitis can include: osteonecrosis from the
disruption of blood circulation within the bone, septic arthritis, impaired
growth if the growth plates are affected, and a higher risk of squamous skin
cell cancer from the damage to the wounded tissue changing the cell
structures. The osteomyelitis can also advance to a bone abscess, such as a
Brodie’s abscess, if left untreated. A Brodie abscess is a sub-acute
osteomyelitis that may persist for years and convert into chronic
osteomyelitis (Walter, Kemmerer, Kappler, & Hoffmann, 2012).

MRI Reasoning
Suzie was given an MRI of her arms and legs to rule out further
involvement of the osteomyelitis into the long bones. Since osteomyelitis is
most common in the long bones in children she is considered high risk for
further development. It is also paramount that she gets fully treated so as
not to affect her growth plates, stunting her growth (Voit et, al, 2015).



Causes of Osteomyelitis
Osteomyelitis can be caused by a number of factors. Traumatic
penetrative injury, bloodstream infections, or local area infection can all be
factors in the development of osteomyelitis. Staphylococcus is the most
common infection to cause osteomyelitis, however, other bacteria and
fungal infections may also cause it. People with diabetes mellitus,
peripheral neuropathy, or peripheral vascular disease are at a higher risk of
developing osteomyelitis. Conditions or patients taking medications that
weaken their immune system are at a higher risk of developing
osteomyelitis as well. Risk factors include cancer, chronic steroid use, sickle
cell disease, human immunodeficiency virus (HIV), diabetes, hemodialysis,
intravenous drug users, infants, and the elderly (Rao, Ziran, & Lipsky,
Osteomyelitis Treatment
Treatment for acute osteomyelitis normally requires and
irrigation and drainage if there is an abscess, along with a culture to specify
the most sensitive antibiotic. If bone needs to be removed, it may need to be
replaced with bone graft or stabilized during surgery. In some instances, the
patient may need to wear a brace for stabilization. If bone needs to be
removed due to excessive damage or osteonecrosis during surgery, a bone
graft may also be necessary. In most cases treatment is effective with
antibiotics and pain medication. The duration of treatment of osteomyelitis



with antibiotics is usually four to eight weeks but varies with the type of
infection and the response to the treatments. The antibiotics normally need
to be intravenous, so the patient will normally also require a PICC line
insertion for the long term antibiotics and they can be taught to administer
their own medications in the comfort of their own home. In some cases the
use of a hyperbaric chamber may prove effective as well in treatment. The
hyperbaric chamber will help promote healing by increasing oxygenation to
the affected tissues, helping them heal faster (Rao, Ziran, & Lipsky, 2011).



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