The xray shows changes noted in chronic osteomyelitis. Chronic osteomylitis is a condition that occurs as a sequel to acute osteomyelitis. Osteomylitis means infection of the bone and bone marrow inmedullary cavity.
In the present film, on left side is a lateral view of lower end of femur with knee joint. On right side is anteroposterior view.
The features that are seen in this xray pointing to probable diagnosis of osteomyelitis are
- Cortical thickening – There appears widening in the part of femur that is 5 cm above knee joint.
- Irregularity of cortices- There is a difference in outline of femoral bone. In the lower part it is very straight and smooth. After that it becomes zigzag.
- Sclerosis- The affected part is more white than the rest of femur if you look carefully.
What else it could be?
In medical terminology this is called differentials. If you just see the xray without seeing the patient, the first thing that comes into mind would be osteomyleitis.
The picture can be confused to some extent with hypertrophic callus in fracture but chances are less likely.
Author Note:
Chronic osteomyelitis classically shows presence of sequestrum or dead bone which is not present in the present film. This was a patient who was just 25 years old and suffered acute osteomyelitis 8 years back. He had come for treatment of stiffness of knee which was present since he had this acute episode.
He did not have any discharging sinus and was not symptomatic for the involved region in the xray.
I have a patient name Shanti 22 yrs old with a staph origin Osteomyelitis. Patient reported a month after she started experiencing pain in her thighs progressing in intensity and saw gradually increasing swelling in her mid thigh.
It was drained within a few hours of her admission.
can you suggest the next course of management means whether to go for curttage and saucerization of bone or not? The X-ray image shows opaque shadow in proximal third of her femur in continuation to the lateral cortex. And while draining some rough area on the bone was felt by the finger tip that can be minute holes in the bone?? Cloaca etc.
Dr Arun Pal Singh Reply:
May 20th, 2009 at 5:53 pm
@Dr Mukesh Prasad,
As you have seen and evaluated the patient, you are the best person to make a decision. Sequestrum removal or aucerizations are known methods of controling infecion in bone.
Please let me know if I could help you in any other way.
Hellow i would like to know the treatment of chronic Osteomyelitis , because i was diagnosed with this disease last year.
Thanks.
Dr Arun Pal Singh Reply:
September 6th, 2009 at 11:00 am
@ABONGILE,
Do you have any symptoms? What part is involved?
Dr .
Can you suggest for patient – age 6 yrs
LT lower femur osteomyelitis – fracture in lower shaft of femur seen – periosteal thickening seen – soft tissue normal
Kindly go through attached last xray investigation report
Surgery Need?
Regards
Ankur Patel
Dr Arun Pal Singh Reply:
November 5th, 2009 at 2:34 pm
@Ankur Patel,
Would you please mail the xrays. I right now have a bad internet connection and files were large for that.
Plus I need to know how long does the child had been having osteomyelitis.
Was there any pus discharge or sinus?
Was there an episode of acute osteomyelitis before this?
How did it get fractured?
Please let me know.
i am a 23 year old young woman and in zimbabwe. io was diagnosed wth chronic osteomyelitis of the left femur abot 13 years ago and i hve had a wound which oozes pus for the last 13 years, i had a sequestration done in 2007 but the wound still continues, i am an orphan and the people whom i stay with cannot afford to pay for treatment and government hospitals in my country are not functining. its my first time to come on this website and i would want to konw more is chronic osteoyelitis life threatenig, does it lead to amputration especially in my case??? my knee was also affected and i walk pulling my leg. its really affe cting me especilly now cause i am more mature and am having mood swings. please help me please
Dr Arun Pal Singh Reply:
February 3rd, 2011 at 2:28 pm
@angeline,
For any help in regard to your disease, you need to see a doctor who could examine and assess your situation.
What kind of help do you want from me?
i juss need any help even information or refer me if you know anyone who can help or a cheap hospital
Dr Arun Pal Singh Reply:
February 12th, 2011 at 8:01 am
@angeline,
You need to search that locally. I think local health care providers might help you.
Good day sir, am a final year medical student . please sir I want to know the xray features of acute osteomyelitis and the teatment modalities
Dr Arun Pal Singh Reply:
March 8th, 2011 at 1:31 pm
@Peter ama,
I have noted that. It would be soon published in http://pro.boneandspine.com
I am 56 , and suffering from chronic osteomyelitis. I was operated in 1971 for septic arthritis in military Hospital ever since then the sinus discharge, and when it stops there is fever. this has affected my upper femur and resulting in permanent disability due to shortage of my leg by 3 and half inches, as the infection has finished the femur ball , there is no movement of my left thigh.
Will it be ever treated ?
Dr Arun Pal Singh Reply:
May 13th, 2011 at 8:39 pm
@Balkrishna Parchure,
Can I see your xray please?
Good Day
I Have a 16 year old son who was diagonised of chronic osteomyelitis of the left tibia, an I & D Was perfomed in 2007 and recently 2011 but its still oozing out pus Can this problem eventually come to an end Please help
Dr Arun Pal Singh Reply:
May 28th, 2011 at 7:58 am
@JOSEPH,
Chronic osteomyelitis is a challenging problem and needs to be treaed agressively. If it is constantly oozing, it means there is a sequestrum or cavity inside and need to be treated accordingly.
Sir, thanks for the reply, I will show my X-Ray, but how I should I do it , Can I scan it and send ?
Dr Arun Pal Singh Reply:
May 28th, 2011 at 1:04 pm
@Balkrishna Parchure,
Please send them to contact [at]boneandspine [dot] com
Thanx Doctor for the advice . You said chronic osteomyelitis needs to be treated accordingly. but my question is how accordingly ?
Dr Arun Pal Singh Reply:
June 9th, 2011 at 3:06 pm
@JOSEPH,
depending on if there is a sequestrum or cavity.
So when there is a sequestram what needs to be done ? Are you in a possition to book me for apponintment in the U K so that he can get better treament in hospitals in the United kingdom ,I
ill cater for the hospital bills since i have other relatives who are well established in the united kingdom
Dr Arun Pal Singh Reply:
June 10th, 2011 at 2:35 pm
@JOSEPH,
It needs to removed. I will not be able to assist you on the other request.
Thanx Doc So Whats the way foward ?
Dr Arun Pal Singh Reply:
June 10th, 2011 at 3:02 pm
@JOSEPH,
You need to see an orthopedist.
Thanx Doc. An I & D Was performed in marchand the wound has healed and since last week its no
longer oozing out pus somy question is that is there no other medication which he can take to aviod
reccurance or swelling of the leg in futere
Dr Arun Pal Singh Reply:
June 14th, 2011 at 7:50 am
@JOSEPH,
If it is not active, all you need to do is wait and watch. The mentioned treatments were only for active discharging lesions.
Thanx doctor
Dr Arun Pal Singh Reply:
June 14th, 2011 at 9:18 pm
@JOSEPH,
Welcome and all the best.