PRESENTOR: DR.

POSIANO PHIRI
INSTRUCTOR: DR SHANKANGA
FIRM: PINK
HISTORY ON 11/03/2022 @ 10:45
 Presenting I.N f/6yrs referal from mwachisompola for further mgt.
 c/o swollen tender left knee joint x14/7. the above c/o was sudden onset and
associated with difficult walking and fevers.
 ROS-NAD
 Pmhx: no hx of chronic illnesses
 Surghx: nil
 Drughx: paracentamol
 Famhx: no hx of chronic illness
 Socialhx : stays with mother in Kambe
 Vitals: T- 37.7 R-19 BP-Not done p-102
 O/E-Gc: stable, afebrile, PoJoCo, chest clear clinically, s1,s2®, P/A –soft.
 L/E- tender warm left knee with reduced ROM. 1ml of pus aspirated from joint.
 IMP: SEPTIC ARTHRITIS
 PLAN: FBC/DC, U & Es + cr, ceftriaxon 500mg bd. Iv , paracentamol 500mg,
po, lt knee xrays ap/l, pus aspirate for mcs
REVIEWS 12 &13 th MARCH , 2022
 Pt complaints remained the same, vitals: T-37.3, R-22
P-100. O/E GC-stable ,afebrile,p0j0c0,chest-clear, cvs-
s1s2 R, P/A- soft,L/E –Tender/swollen lt knee.
 FBC RESULTS: WBC-1800, HB-10.1,PLT-266
 Plan: anthrocentesis done -3mls pus drained,drugs as
per chart, cold compress, f/p-labs. Xray-Reviews
SUBQUENT REVIEW 0N 05/04/22
 PT Review, case of septic arthritis ? Pyomyositis.
 c/o no new complaint
 Xray-reviews showed extensive lt femur involvement
with massive loss of bone density
O/E
 GC-stable afebrile,pojoco, RS/CVS-Normal , P/A-Soft, L/E-
Swollen lt knee with reduced ROM.
 IMP: CHRONIC OSTEOMYELITIS
 PLAN: Ciprobid 250mg po x1/12, metronidazole 200mg po
x 1/12, paracentamol 500mg tds po x 3/7
 Bed rest, allow home review 20/04/22 surgical clinic.
 On 20/04/22 pt came for review in the clinic from which
she was re-admitted to the hospital for spiking fevers and
after being on the ward for 3 days patient was discharged on
antibiotics and plan to treat palliatively was made. Possible
crutch/ walking aids to help with ambulation.
GOALS OF TREATMENT OF
C.OSTEOMYELITIS
 Treatment of c.osteomyelitis is multidisplinary-
microbiologist,radiologist,surgeons, physiotherapist etc……

 Optimal antibiotic selection,adquate dosing and prolonged antiobitic course

with monitoring for clinical response/toxicity of therapy. Antibiotic of choice is
made after MCS of bone aspirate
 In case of inadquancy of investigation for sensitivity, the usual choice of drugs
is antistaphylococcal i.e nafcillin,, vancomycin, clindamycin and cefozolin. Iv
antibiotic for 3-6wks until crp normalises.
 Surgical care: pts may require bone biopsy to ensure correct diagnosis and
appropriate antimicrobial therapy
 Consultation with orthopedic surgeons is necessary for inquiry if surgical
treatments available
 Nutrition : no specific diet is recoomended
 Activity: weight bearing and agrresive activities should be restricted until
infection and treatment completed
Surgical mx
 The cornerstone-surgical debridement and
reconstruction of bone and local tissues
 Reamerirrigator aspirator
 Conventional reaming of the intramedullar canal-
good as clears intramedularly sepsis
 RIA- Less traumatic than conventional reaming
 - clears intramedular sepsis
 References
 Medscape
 Schmitt SK. Osteomyelitis. Infect Dis Clin North Am.
2017 Jun;31(2):325-338. [PubMed]

 . Forsberg JA, Potter BK, Cierny G, 3rd, Webb L.

Diagnosis and management of chronic
infection. J Am Acad Orthop Surg 2011;19:S8-S19.
[PubMed] [Google Scholar]