Iatrogenic chronic osteomyelitis of the clavicle: a rare case presentation

Abstract

Chronic osteomyelitis of the clavicle is a rare clinical entity, as it is an uncommon infection at uncommon location. This is a case report of a young male with chronic osteomyelitis of the clavicle following surgical intervention after a traumatic fracture of left clavicle, highlighting diagnostic challenges, radiological features, surgical management, and favorable outcomes. A 24-year-old Indian male farmer presented with a 4-month history of a discharging sinus over the midshaft of the left clavicle. He had sustained a clavicular fracture five months earlier, managed elsewhere with K-wire fixation, followed by implant removal after one month. Subsequently, he developed a persistent discharging sinus without systemic symptoms. Clinical examination revealed local tenderness, induration, and purulent discharge. Laboratory investigations showed elevated ESR (65 mm/hr) and CRP (42 mg/l). Culture from the sinus discharge yielded methicillin-sensitive Staphylococcus aureus (MSSA). Radiographs demonstrated sclerotic changes with patchy rarefaction suggestive of chronic osteomyelitis. The patient underwent surgical debridement and sequestrectomy. Intraoperatively, necrotic bone and sinus tracts were excised completely. Postoperatively, he received culture-sensitive antibiotics for six weeks. The wound healed primarily, inflammatory markers normalized, and shoulder function recovered fully without recurrence. This case underscores the importance of considering osteomyelitis as a differential diagnosis in patients presenting with chronic sinus formation after clavicular surgery. Prompt surgical management combined with targeted antibiotic therapy ensures optimal recovery and prevents recurrence. As iatrogenic chronic clavicular osteomyelitis is rarely reported, this case enhances clinical awareness among orthopaedic surgeons and broadens current understanding of post-operative bone infections in uncommon anatomical sites. It highlights that timely diagnosis and radical debridement can yield excellent functional and infection control outcomes.