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Fulltext Non-bacterial chronic recurrent osteomyelitis of the clavicle

Pan K, Chan W, Ong G, Zulqarnaen M, Norlida D

Malays Orthop J, 2012 Mar;6(1):57-60.
PMID: 25279046 MyJurnal DOI: 10.5704/MOJ.1203.005

This report details the case of a 12-year-old girl with a painful, progressive swelling of the medial portion of the clavicle with no history of trauma or other constitutional symptoms. All laboratory investigations were normal except for an elevated erythrocyte sedimentation rate (ESR). Initial plain radiographs showed a destructive lesion with magnetic resonance imaging showing features of malignancy. Biopsies revealed osteomyelitis, but with negative bacterial cultures and no evidence of malignancy. Treatment with antibiotics did not result in a favourable response. Over time, the swelling increased in size with episodic exacerbations of pain. Follow-up radiographs showed sclerosis and hyperostosis. After five years, this was recognized as non-bacterial chronic recurrent osteomyelitis of the clavicle.

Matched MeSH terms: Osteomyelitis
Fulltext Radiofrequency ablation of a misdiagnosed Brodie's abscess

Chan R, Abdullah B, Aik S, Tok Ch

Biomed Imaging Interv J, 2011 Apr;7(2):e17.
PMID: 22291860 DOI: 10.2349/biij.7.2.e17

Radiofrequency ablation (RFA) therapy is recognised as a safe and effective treatment option for osteoid osteoma. This case report describes a 27-year-old man who underwent computed tomography (CT)-guided percutaneous RFA for a femoral osteoid osteoma, which was diagnosed based on his clinical presentation and CT findings. The patient developed worsening symptoms complicated by osteomyelitis after the procedure. His clinical progression and subsequent MRI findings had led to a revised diagnosis of a Brodie's abscess, which was further supported by the eventual resolution of his symptoms following a combination of antibiotics treatment and surgical irrigations. This case report illustrates the unusual MRI features of osteomyelitis mimicking soft tissue tumours following RFA of a misdiagnosed Brodie's abscess and highlights the importance of a confirmatory histopathological diagnosis for an osteoid osteoma prior to treatment.

Matched MeSH terms: Osteomyelitis
Spectra of central nervous system melioidosis

Muthusamy KA, Waran V, Puthucheary SD

J Clin Neurosci, 2007 Dec;14(12):1213-5.
PMID: 17964168

Burkholderia pseudomallei infection of the central nervous system (CNS) is rare with less than 50 cases reported over the last 30 years. The retrospective melioidosis study at University Malaya Medical Centre has documented three cases of CNS melioidosis out of more than 160 cases of melioidosis since 1978. There were two patients with brain abscess and one with spinal epidural abscess. The predisposing factors were: one patient was an aboriginal farmer and the other two were diabetic. Their age ranged from 17 to 45 years. Prominent neurological features were limb weakness, cranial nerve palsy (6th and 7th) and visual disturbance. CT brain scan and MRI spine showed abscess formation, subdural collection, and spinal epidural collection, osteomyelitis of vertebra and occipital bone and also sagital sinus thrombosis. All these patients underwent surgical drainage leading to bacteriological diagnosis as well as appropriate long-term antibiotic therapy. All had good recovery at 6 months after completion of treatment.

Matched MeSH terms: Osteomyelitis/etiology; Osteomyelitis/microbiology; Osteomyelitis/pathology
Fulltext Close fracture complicated by acute haematogenous osteomyelitis

Baskaran S, Nahulan T, Kumar AS

Med J Malaysia, 2004 Dec;59 Suppl F:72-4.
PMID: 15941170

This is the first time we encountered a peculiar case of osteomyelitis complicating a closed fracture. The patient was a 38 year-old lady who presented just like any other patient with a closed fracture of the right femur. Intraoperatively we were surprised to find pus from the fracture site. This not only changed the surgical management but altered the subsequent outcome as well.

Matched MeSH terms: Osteomyelitis/diagnosis; Osteomyelitis/etiology*; Osteomyelitis/therapy
Fulltext Chronic Osteomyelitis Revisited: A Case Report

Chuah SK, Bajuri MY, Mohd Nor F

Cureus, 2019 Jun 28;11(6):e5023.
PMID: 31501722 DOI: 10.7759/cureus.5023

Chronic osteomyelitis treatment is always a challenge to orthopaedic surgeons which requires great dedication and perseverance. We report a successful limb salvage case of a 46-year-old man who suffered from a left tibia chronic osteomyelitis with soft tissue defect. The treatment approach was a thorough wound debridement of devitalized tissues and necrotized bone, commencement of culture-directed antibiotics, reconstruction with vascularized osteomyocutaneous fibula flap, and skeletal stabilization with internal fixation. As compared to below knee amputation, the result we obtained in this case is more promising with regard to mobility and function.

Matched MeSH terms: Osteomyelitis
Fulltext Physical and chemical stability of ceftaroline in an elastomeric infusion device

Al Madfai F, Zaidi STR, Ming LC, Wanandy T, Patel RP

Eur J Hosp Pharm, 2018 Oct;25(e2):e115-e119.
PMID: 31157080 DOI: 10.1136/ejhpharm-2017-001221

Background: Severe infections such as endocarditis and osteomyelitis require long-term treatment with parenteral antibiotics and hence prolonged hospitalisation. Continuous infusion of ceftaroline through elastomeric devices can facilitate early hospital discharge by managing parenteral antibiotics in patient's home. Therefore, the purpose of this study was to investigate the stability of ceftaroline in a commonly used elastomeric device.
Method: A total of 24 elastomeric devices were prepared, and six elastomeric devices containing 6mg/mL of ceftaroline (three in each type of diluents) were stored at one of the following conditions: 4°C for 6 days, 25°C for 24hours, 30°C for 24hours or 35°C for 24hours. An aliquot was withdrawn before storage and at different time points. Chemical stability was measured using a stability indicating high-performance liquid chromatography, and physical stability was assessed as change in pH, colour and particle content.
Results: Ceftaroline, when admixed with both diluents, was stable for 144, 24 and 12hours at 4°C, 25°C and 30°C, respectively. At 35°C, ceftaroline admixed with normal saline (NS) and glucose 5% was stable for 12hours and for 6hours, respectively. No evidence of particle formation, colour change or pH change was observed throughout the study period.
Conclusions: Our findings support 12 or 24hours continuous elastomeric infusion of ceftaroline-NS admixture, and bulk preparation of elastomeric pumps containing ceftaroline solution in advance. This would facilitate early hospital discharge of patients eligible for the elastomeric-based home therapy and avoid the need for patient's caregivers travelling to the hospital on a daily basis.

Matched MeSH terms: Osteomyelitis
Fulltext False Negative (99m)Tc-Hydroxymethane Diphosphonate Three-phase Bone Scintigraphy and (99m)Tc-besilesomab Scan in Detecting Tibia Osteomyelitis Concomitant with Necrotizing Fasciitis

Tan TH, Lee BN

World J Nucl Med, 2014 Sep;13(3):190-2.
PMID: 25538491 DOI: 10.4103/1450-1147.144820

We described a case of 51-year-old female patient presented with a right calf necrotising fasciitis (NF) where osteomyelitis (OM) was suspected. (99m)Tc-hydroxymethane diphosphonate three-phase bone scintigraphy and (99m)Tc-besilosomab scan failed to demonstrate classical features of OM. The final diagnosis was only made by isolating Acinetobacter sp. in both intra-operative bone and tissue cultures from below-knee amputation. As conclusions, the detection of lower limb OM by (99m)Tc-besilosomab scan is not easy when there is concurrence overlying NF. The unusual three-phase bone scan finding of pericortical accumulation of tracer as an early sign of OM is highlighted in this case.

Matched MeSH terms: Osteomyelitis
Chronic granulomatous disease

Zarina Thasneem Zainudeen, Ilie Fadzilah Hashim, Intan Juliana Abd Hamid

Malaysian Journal of Paediatrics and Child Health, 2019;25(2):1-2.
MyJurnal

Chronic granulomatous disease (CGD) is defined as an inherited phagocyte disorder causing defective superoxide generation and intracellular killing. Reduced or missing burst activity of nicotinamide dinucleotide phosphate (NADPH) oxide complex is observed in this inborn defect that usually manifests itself during the first two years of life. It can be inherited either by X-linked inheritance or autosomal recessive inheritance. Most patients with CGD develop failure to thrive, severe bacterial adenitis, abscesses, osteomyelitis or hyperinflammaory manifestations. (Copied from article).

Matched MeSH terms: Osteomyelitis
Toxoplasma encephalitis in acquired immunodeficiency syndrome: a case report

Yoong KY, Cheong I, Choy KC

Family Physician, 1995;7:24-27.

A 32 year old HIV positive intravenous drug user (IVDU) with a promiscuous lifestyle in the past presented with altered behaviour and was diagnosed to have pulmonary tuberculosis, tuberculous meningitis and tuberculous osteomyelitis. After initial response to anti-tuberculous therapy, his symptoms recurred with the appearance of cerebral mass lesions. A presumptive diagnosis of toxoplasma encephalitis was made based on clinical, serological and radiological evidence. He showed clinical improGement with anti-toxoplasmic therapy.

Matched MeSH terms: Osteomyelitis
Fulltext Osteomyelitis post acromioclavicular joint reconstruction

Yeak RD, Daud H, Nizlan NM

Chin J Traumatol, 2019 Jun;22(3):182-185.
PMID: 31060897 DOI: 10.1016/j.cjtee.2019.03.004

Acromioclavicular joint (ACJ) injury is a common shoulder injury. There are various techniques of ACJ reconstruction. Superficial infection after ACJ reconstruction is not an uncommon complication. However, osteomyelitis post ACJ reconstruction has never been highlighted as a possible complication. Our patient is a 31-year-old male who sustained a Rockwood 5 ACJ dislocation and had anatomical ACJ reconstruction with autogenous gracilis and semitendinosus graft. Our technique involved the anatomical reconstruction of the ACJ and the coracoclavicular ligament with the usage of two bioscrews and the temporary stabilisation of the ACJ with two k-wires. As in any orthopaedic surgery, infection is often disastrous especially when the surgery involves implants. It can be disastrous with high morbidity to the patient as well as a costly complication to treat. Therefore, we wish to highlight this case as despite its rarity, osteomyelitis can be devastating to the patient and should be prevented if possible.

Matched MeSH terms: Osteomyelitis/etiology*; Osteomyelitis/prevention & control; Osteomyelitis/therapy*
Candida Skull Base Osteomyelitis: a Case Report and Literature Review

Krishnamoorthy M, Othman NAN, Hassan NEB, Hitam SB

Acta Medica (Hradec Kralove), 2020;63(2):82-85.
PMID: 32771074 DOI: 10.14712/18059694.2020.22

Skull base osteomyelitis (SBO) also commonly known as malignant otitis externa was first described by Meltzer and Kelemen in 1959. Prior to the advent of the antibiotic era, this disease carried a poor prognosis with significant morbidity. It often proved fatal with mortality rates as high as 50%. Commonly seen in the immunocompromised patients, diabetes mellitus is an important associated comorbidity in the pathophysiologic development of this disease. Treatment is instituted by medical therapy with surgery having a limited role. Surgical intervention has a limited role, for example, in fungal SBO. Such cases may require local debridement and intraoperative tissue biopsies for histopathologic confirmation. This is to demonstrate fungal invasion into the skull base, as well as to exclude other sinister differential diagnoses like squamous cell carcinoma of temporal bone. In this case report, we present a rare case of candida SBO and the literature review.

Matched MeSH terms: Osteomyelitis
Fulltext Antibacterial efficacy and drug-release behavior study of β-tricalcium phosphate micro-granules against staphylococcus aureus and Escherichia coli

Nor Hazliana Harun, Rabiatul Basria S.M.N. Mydin, Khairul Anuar Shariff, Nur Adila Rosdi, Davamunisvari Rames

Malaysian Journal of Medicine and Health Sciences, 2020;16(3):202-206.
MyJurnal

Introduction: This study aims to investigate different residue sizes of β-tricalcium phosphate (β-TCP) micro-granules as carriers to assess antibacterial activity and drug-control release behavior of ampicillin (AMP-) and antimycotic (AMC-). Incorporation of antibiotic into the β-TCP micro-granules and it sustain release behavior could be used as alternative solution to reduce the risk of osteomyelitis and bone infections risks. Methods: Three different residue sizes (less than 300 µm, 300 µm and 600 µm) were prepared and coated with antibiotics solution (20 µg/µl of ampi- cillin and 100X antimycotic solution) by using two methods; dip and stream coating. After 72 h, 1.5 mL of distilled water was added to the treated (β-TCP) micro-granules at two different pH value (5.0 and 7.4). The extracted solution was further analyzed by Kirby Bauer disc diffusion test and spectrophotometer assay. Results: The solution con- taining AMC-(β-TCP) micro-granules with the size of 300 µm residue produced the largest inhibition zones against Escherichia coli (E. coli). All residue sizes coated with AMP- showed no antibacterial activity against both strains; Staphylococcus aureus (S. aureus) and E.coli. Additionally, the release behavior of AMC-(β-TCP) micro-granules was found not depending on the pH, but on the size of residue. Complete drug release was rapidly observed within 48
h. Conclusion: Based on this findings, it showed AMC-(β-TCP) micro-granules had an antibacterial activity against Gram-negative strain. Specifically, it can reduced the growth rate of E. coli and the rapid release behavior of AMC- (β-TCP) micro-granules help in minimizing the risk-infections in early stage of implantation.

Matched MeSH terms: Osteomyelitis
Fulltext 13-year-old exposed interlocking nail: a case report

Chua, Y.C.J., Lim, L.A., Hudzairy, A.

Malays Orthop J, 2009;3(1):91-94.
MyJurnal

We are reporting a case of post-traumatic chronic osteomyelitis of the tibia with an open wound exposing an intra medullar nail implant for 13 years. The patient presented with fresh ipsilateral tibia plateau fracture. He was treated by removal of the implant, debridement and local placement of Gentamicin-impregnated PMMA beads according to guidelines of two-stage Belfast technique . After five months of wound treatment, the exposed bone was covered by healthy granulation tissue and the patient was able to fully bear weight.

Matched MeSH terms: Osteomyelitis
Fulltext Negative pressure wound therapy: Has it made a revolution in wound management?

Al-Shaham, Ali Abbas Hadi, Al-Shaham, Serene Ali, Jerjess, Mustafa

Medical Health Reviews, 2009;2009(1):3-13.
MyJurnal

Negative pressure if applied in topical manner to a wound surface has been reported to enhance wound healing due to increase in local blood flow, reduction of tissue oedema, and by stimulating angiogenesis. An air-tight film covering the wound is connected by suction tube to a control unit by which negative pressure is applied to the surface of the wound in the range of 80-125 mm Hg. This method has been called negative pressure wound therapy (NPWT) or vacuum assisted closure (VAC). It has been recommended for virtually all kinds of complex wounds. The duration of the therapy varies from several days to several months. This technology promotes formation of granulation tissue, enhances healing of diabetic foot, and significantly reduces the size of the acute and chronic wounds and ulcers. It lowers the morbidity of Fournier’s gangrene, ensures better healing of lower limb wounds and ulcer of ischemic origin, and can serve as temporary wound cover when no closure technique is available. The limitations to using NPWT are presence of dead tissue, exposed vital structures, untreated osteomyelitis, unexplored fistulae and malignant wounds. The cost of the equipment may constitute another factor in limiting the use of this new technology. In conclusion the NPWT under certain circumstances is more effective than other available local wound treatments.

Matched MeSH terms: Osteomyelitis
Fulltext Spinal tuberculous disease is common in tuberculous meningitis

Tai, Sharon Mei-Ling, Hazman Mohd Nor, Kartini Rahmat, Pow, Zhen Yuan, Ong, Lay Sim, Tan, Chong Tin, et al.

Neurology Asia, 2017;22(4):313-323.
MyJurnal

Background: Tuberculous disease of spine (spinal TB) is under-recognized in tuberculous (TB) meningitis.
The objective of the study was to evaluate the frequency, clinical and neuroimaging changes, and
outcome in the patients with spinal TB.

Methods: All the patients with spinal TB admitted in the two
largest tertiary hospitals in Kuala Lumpur from 2009 to 2017 were recruited, the clinical features were
documented, the magnetic resonance imaging (MRI) of the spine was performed. Clinical outcome was
assessed with Modified Rankin scale (MRS).

Results: Twenty two patients were recruited. This was
out of 70 TB meningitis patients (31.4%) seen over the same period. Eighteen (81.8%) patients had
concomitant TB meningitis. The clinical features consisted of systemic symptoms with fever (63.6%),
meningitis symptoms with altered sensorium (45.5%), myelopathy with paraparesis (36.4%). The
findings on spinal MRI were discitis (36.4%), spinal meningeal enhancement (31.8%), spinal cord
compression (31.8%), psoas abscess (27.3%), osteomyelitis (22.7%), and cord oedema (22.7%). All
except two patients (90.9%) had involvement in psoas muscle, bone or leptomeningeal enhancement,
features that can be used to differentiate from myelopathy that affect the parenchyma only, such as
demyelination. Unusual manifestations were syringomyelia and paradoxical manifestations seen in 3
patients each. The outcome were overall poor, with 68% having MRS 3 or more.

Conclusion: Spinal TB is common in TB meningitis. The outcome is overall poor. A heightened
awareness is crucial to enable early diagnosis and treatment.

Matched MeSH terms: Osteomyelitis
Fulltext Tc99m-besilesomab with the added benefit of Single Photon Emission Computed Tomography/Computed Tomography (spect/ct): current role in infection detection and localisation

Farahnaz Mohamed Aslum Khan, Siti Zarina Amir Hassan, Noor Khairiah A. Karim, Khadijah Abdul Hamid, Leong, Chee Loon

Malaysian Journal of Medicine and Health Sciences, 2018;14(201):1-8.
MyJurnal

Imaging modality has become increasingly important in hospital setting especially in cases of unknown site of infection/pyrexia of unknown origin (PUO) and osteomyelitis (OM). In recent years, nuclear imaging has been used and is known to deliver prompt and precise diagnoses of numerous infectious diseases. The purpose of the study is to detect and localise the site of infection using Tc99m-besilesomab and to assess the added contributions of single photon emission computed tomography/computed tomography (SPECT/CT) over planar scan in patients with PUO and OM. Methods: Tc99m-besilesomab with SPECT/CT were prospectively performed in 23 patients (eight males, 15 females) with suspected infection. True findings were diagnosed by both cold and hot spot in the scan with reference to positive blood or tissue cultures, or other additional imaging. Results: Tc99m-besilesomab managed to detect presence of infection with high sensitivity of 87.5% and specificity of 71.4%. Interobserver variability agreement that was obtained between the presence of infection and the ability of Tc99m-besilesomab imaging to detect it was significant (p

Matched MeSH terms: Osteomyelitis
Fulltext Calf Compartment Syndrome associated with the Use of an Intra-osseous Line in an Adult Patient: A Case Report

Malhotra R, Chua WL, O'Neill G

Malays Orthop J, 2016 Nov;10(3):49-51.
PMID: 28553450 DOI: 10.5704/MOJ.1611.014

We present a case of a lower limb compartment syndrome associated with the use of an intra-osseous line inserted into the proximal tibia in an adult patient. An unconscious 59-year old male with multiple injuries presented to our Emergency Department after a road traffic accident. Bilateral proximal tibial intra osseous-lines were inserted due to poor venous access. After resuscitation his left leg was noted to be tense and swollen with absent pulses. Acute compartment syndrome was diagnosed both clinically and with compartment pressure measurement. Two incision fasciotomy on his left lower leg was performed. Intra osseous-lines in the proximal tibia are increasingly used in adult patients in the pre-hospital setting by paramedics and emergency physicians. Their use, along with the possible complications of these devices, such as the development of compartment syndrome or osteomyelitis leading to amputation, is well reported in the paediatric literature. To the best of our knowledge, there have not been any previous reports of complications in the adult patient. We present a case of lower leg compartment syndrome developing from the use of an intra-osseous line in the proximal tibia in an adult patient. With the increasing use of intra-osseous lines in adult patients, clinicians should be aware of the possibility of developing compartment syndrome which may lead to disability or amputation in severe cases.

Matched MeSH terms: Osteomyelitis
Functional outcome and quality of life following treatment for post-traumatic osteomyelitis of long bones

Zayzan KR, Yusof NM, Sulong AF, Zakaria Z, Ab Rahman J

Singapore Med J, 2020 Dec 02.
PMID: 33264560 DOI: 10.11622/smedj.2020164

INTRODUCTION: The clinical outcomes and factors associated with treatment failure of post-traumatic osteomyelitis have been investigated by many studies. However, limb functionality and quality of life following treatment for this condition have not been thoroughly studied.
METHODS: This was a cross-sectional study that included 47 patients with post-traumatic osteomyelitis of the lower limb. Functional outcome was assessed using the Lower Extremity Functional Score (LEFS), and quality of life was assessed using the validated Malay version of Short Form-36 version 2.
RESULTS: Mean follow-up time was 4.6 (range 2.3-9.5) years. Median age was 44 years. Osteomyelitis was located in the tibia for 26 patients and in the femur for 21 patients. Osteomyelitis was consequent to internal infection in 38 patients and due to infected open fractures in nine patients. 42 (89.4%) patients had fracture union and control of infection. Bone defect was found to be a significant contributing factor for treatment failure (p = 0.008). The median LEFS for the success group was 65 when compared to 49 for the failure group. Although the success group showed better scores with regard to quality of life, the difference between the two groups was not statistically significant.
CONCLUSION: The success rate for post-traumatic osteomyelitis of the lower limb was high. The presence of a bone defect was associated with treatment failure. Successfully treated patients had significantly better functional outcomes than failed ones.

Matched MeSH terms: Osteomyelitis
Fulltext Venous gas embolism following hydrogen peroxide irrigation during debridement of chronic osteomyelitis lesion

Shukrimi A, Aminudin CA, Azril MA, Hadi MR

Med J Malaysia, 2006 Feb;61 Suppl A:88-90.
PMID: 17042238

We report a case of a previously healthy 53-year-old man who developed an intra-operative catastrophic event occurring in association with the use of hydrogen peroxide for wound irrigation following surgical debridement of a chronic osteomyelitis lesion of the humerus. It is our intention to highlight this potentially fatal consequence of hydrogen peroxide irrigation as part of bone debridement procedure. This case will serve as a reminder to orthopaedic surgeons who frequently use hydrogen peroxide in their surgical practice.

Matched MeSH terms: Osteomyelitis/surgery*
Musculoskeletal lesions in yaws

Sengupta S

Clin Orthop Relat Res, 1985 Jan-Feb;?(192):193-8.
PMID: 3967422

Yaws, a spirochetal infection that is endemic in certain tropical countries, including Malaysia, may present with various orthopedic problems. As the condition is relatively unknown, diagnosis is often missed, which leads to poor management. There are initial, early, and late phases of the disease process. By involving skin, bone, and joints, yaws can produce deep ulcerations, joint deformities, and bone destruction. Within a ten-year period in Malaysia, 14 cases of serologically proven yaws have been treated for chronic ulcers, gross joint deformities, and pathologic fractures.

Matched MeSH terms: Osteomyelitis/etiology

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