Anaerobic osteomyelitis of femoral head with intraosseous, intra-articular, bursal and muscle pneumatosis

Potocki, Jason; Kaushik, Shaifali; Mira, Jose L.

doi:10.1007/s00256-002-0567-z

Cited by 31 publications

(16 citation statements)

References 6 publications

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“…There have also been cases of polymicrobial osteomyelitis [5], among which anaerobic germs were included. The most common locations are the pelvis, tibia, fibula, femur and vertebrae [6] and sometimes they are related to diseases such as lymphangiomatosis, necrosis, neoplasia, fractures, penetrating trauma, or previous surgeries [7], or even in relation to gaseous gangrene in diabetic feet [8].…”

Section: Casementioning

confidence: 99%

Intramedullary Gas not Related to Infection

Barquiel¹

2017

J Musculoskelet Disord Treat

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The presence of gas in joints or soft tissues is usually indicative of infectious pathology or degenerative diseases [1]. However, the presence of gas inside the medullary canal in the diaphysis of long bones is an uncommon condition, and it is often associated with fractures or previous surgeries.We present the case of a 29-year-old man who suffered an open supraintercondylar femur fracture, treated with debridement, surgical scrub with saline solution, and stabilization by external fixator, and in a second stage with a definitive osteosynthesis, which after being washed with pressure gun presented abundant intramedullary gas non-related to infectious pathology but possibly related to a pulsatile jet lavage during surgery. CASE REPORTture; 2: articular simple, metaphyseal multifragmentary) supraintercondylar fracture of the right femur with Gustilo-Anderson type IIIA ( Figure 1A), and an AO34-C1 (3: femur; 4: patella; C: complete articular; 1: transverse) non-displaced fracture of the right patella. Extensive wound cleaning was immediately performed at the emergency department, with manual irrigation using saline solution, as well as debridement of the most superficial contaminant material and temporary approximation of the wound edges. According to our hospital open fracture protocol, intravenous antibiotherapy was initiated with cefuroxime 1 g every 8 hours for 3 days and gentamicine 240 mg every 24 h for 3 days.He was taken to the operation room where we conducted first an antegrade intramedullary nailing of the left femur with a Synthes Expert femoral nail, using a traction table. Secondly, on the right femur, we performed a resection of the wound edges according to Friederich, a debridement of the contaminating deep tissue and the fracture focus, manual wound cleaning with saline irrigation, and temporary fixation of the supracondylar fracture with an external fixator (Hoffman II, Synthes). Given the fact that the patella fracture was non-displaced, there were no more surgical procedures.Subsequently, a CT scan of the right knee was performed in order to complete the preoperative studies so we could make a good surgical planning ( Figure 1B), which did not show any intraosseous air bubbles. After CaseThe patient is a 29-year-old man with no history of interest, who was taken to our hospital on November 2015 approximately one hour after suffering a high energy traffic accident. He was a motorbike rider hit by a car riding at high speed. He was received at the emergency department where advanced life support measures were applied. After the stabilization of the patient, the body-CT showed contusive focus in both pulmonary bases, discarding other internal emerging lesions.In the radiological series, we identified an AO32-B2 (3: femur; 2: diaphyseal; B: with a wedge fragment; 2: bending wedge) fracture of the left femur, an open AO33-C2 (3: femur; 3: distal; C: complete articular frac-

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Section: Casementioning

confidence: 99%

Intramedullary Gas not Related to Infection

Barquiel¹

2017

J Musculoskelet Disord Treat

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“…Dieser Befund ist selten und ein Hinweis auf eine Knocheninfektion mit Anaerobiern (Potocki et al 2002;vgl.Abb. 4.8).…”

Section: Radiologische Symptomatikunclassified

Osteomyelitis

Bohndorf¹,

Bühne²

2005

Handbuch Diagnostische Radiologie

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“…This condition is extremely rare, particularly in the absence of a compound fracture, surgery or other direct communication between the bone and air [2]. The pathogens are often polymicrobial and anaerobic.…”

Section: Introductionmentioning

confidence: 99%

“…The pathogens are often polymicrobial and anaerobic. The presumed mechanism for the formation of intraosseous gas involves anaerobic metabolism with the production of hydrogen and carbon dioxide [2]. Anaerobic osteomyelitis can become fulminant and invasive.…”

Section: Introductionmentioning

confidence: 99%