A rare case of acute osteomyelitis in a 13-year-old with physeal involvement

Abstract

Osteomyelitis of epiphyses in adolescents is a rare finding. We evaluate one such case in which high degree of clinical suspicion and prompt surgical intervention yielded good functional results. This is a case report of 13-year-old girl diagnosed with osteomyelitis of right knee. MRI is suggestive of physeal involvement. Physeal involvement makes the management very challenging. Surgical intervention was planned to reduce bacterial load and minimize possibility of damage to knee joint (articular cartilage and joint capsule). Lateral and posterior compartment of leg was decompressed, fibular osteotomy done, drilling in tibial epiphyseal and metaphyseal region of tibia done avoiding any injury to growth plate. Pus for culture and sensitivity and specific antibiotics started with monitoring of blood parameters for infection like ESR, CRP, TLC. Patient taken up for second debridement after one week of index surgery. After 6 weeks of intravenous antibiotic patient discharged in afebrile state with reduced values of blood parameters and acceptable range of knee movement. Lower extremity functional scoring (LEFS) of 45/80 i. e., 56.83 % at the end of 4 months. Good functional outcome at the end of 1 year. Early clinical suspicion with prompt investigation, surgical and medical management gives promising result.