An Interesting case of osteomyelitis of humerus with bone defect for management -Case report

BACKGROUND High rate of prevalence of chronic osteomyelitis in children is posed with lot of problems which makes it difficult to treat. One such case of chronic osteomyelitis humerus with bone defect is discucced here.AIM To get Good functional outcome in a 15 year old girl with chronic osteomyelitis humerus associated with bone defect.MATERIALS AND METHODS A 15 year old girl was admitted in Our hospital with complaints of history of fall 1 yr back and injured left arm. She wasnot able to move her arm after fall for which she had native treatment with splitting for 3 months. She developed blisters in skin and discharging pus from left arm. Debridement was done and external fixator applied elsewhere. She presented to us with complaints of discharging sinus with arm in external fixator. Problems to be addressed in her are Chronic osteomyelitis with discharging sinus, Defect Non-union Proximal humerus, Subluxed Humeral head, avascular necrosis of humeral head, Limb length discrepancy of 6 cm (Acromion to lateral condyle), Hyposthesia of skin over the area supplied by axillary nerve. Initial debridement after sending pus Culture and sensitivity was done. Antibiotics started according to the report. We Waited till sinus became completely dry. Once three consecutive CRP normal levels were obtained we proceeded with surgical intervention. Surgically she was proceeded with a Non- Vascularised fibular Allograft, Augmented with cancellous iliac crest graft, Distally fixed the graft with LCP and proximally stabilised with K wire. Post-operatively arm was immobilized for two months. K wire was taken out at two months. Patient was on regular follow for one year.RESULT Girl had a good available range of motion, with Good Functional improvement able to carry out her daily routines.