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 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.
@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
@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
@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
@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
@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 ?
@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
@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 ?
@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 ?
@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
@JOSEPH,
It needs to removed. I will not be able to assist you on the other request.
Thanx Doc So Whats the way foward ?
@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
@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
@JOSEPH,
Welcome and all the best.
Hi All
Interesting topics you have. I am a recovered chronic osteomyletis patient. I was diagnosed with this disease in 1997, i was only 15 years at the time. I had a surgery to clean up the puss on top of the left femur and right arm. I was okay for the next three years, till mod 2000 when a sinus developed and started ooxinf profusely. I underwent through various anitbiotic treatments between 2000 and 2003. Had numerous surgeries performed including removal of the sequesttum and all but nothing helped, had gentinbeads inserted and all but still nothing, my surgeon even suggested amputation to which i refused. In fact during one operation my femur fractured and when the a new bone was growing it sort of protruded to the left and now i have bracket shaped left leg, which i have accepted after a long time and i am now happy with. I eventually got hold of Prof Lautenbach at Milpark hospital in Johannesbrug, South Africa and he did a DRI.. Debridement Remury Irrigation. This was done over a period of six weeks in hospital. And i have to say that after this procedure. I never had a problem with any of my bones etc. I can say I am healed. Imagine what could have happened had i given in to an amputation.
Hello doc, i got involved in an autocrash 6yrs ago and had multiple fracture on my both legs n ribs. I had several surgeries in which plates n nail were used. I have been diagnosed with chronic osteomylitis n have been discharging puss 4rm both legs. I treated d infection 2yrs ago by removin d implant placed on antibiotics 4 6months, after which another surgery was carried out n new implants were fixed in both legs. After some weeks, both legs started discharging puss again n i have severe pains on my bones. My doctor said im reacting 2 d implants so i have 2 undergo another surgery again. I am tired of the pain n surgeries, how can u pls help me. Whats d treatment for it? How long is the treatment? Is there any other method of surgery apart 4rm the use of implants? I have bone grafts on both legs.
@Le'an Bensatt,
Can I have a look at your xrays please.