Rare Case Of Exostosis Following Dog Bite: A Case Report

Abstract

Dog bites are major public health problems(4). These are associated with acute and chronic complications needing admission to the hospital. Acute complications include life threatening rabies, various types of infections with associated complications(3), soft tissue loss and fractures(1). Chronic complications in the form of cosmetic deformities and chronic osteomyletis(2) are well documented. Dog bites are contaminated wounds and convention dictates that any surgical treatment should be performed at the earliest opportunity(5). We present a rare case of exostosis in the tibia one year following dog bite. CASE REPORT A 19 year girl presented to the plastic surgery following an English terrier bite on the left leg. She had an open wound of about 4-5cms with loss of skin. This was managed with early debridement and secondary intention wound healing. At the time of presentation, x-ray revealed no bony injuries. The wounds healed well and the patient was followed up in the clinic. One year later, patient complaint of noticing a bone swelling at the site of now well healed wound. X-ray revealed a bony spicule( Fig 1). Figure 1 Figure 1: Showing bone spicule Rare Case Of Exostosis Following Dog Bite: A Case Report 2 of 3 There was no recent history of injury to the area. It was thought that periosteal stripping followed by a phenomenon of exostosis might have lead to the formation of the bone spicule. A decision of removal of the bony spicule was made. DISCUSSION Dog bites are known to cause complications. These complications include early and late complications. Most dreaded complication includes rabies. Early debridement and appropriate treatment is necessary. Bone complications in the form of osteomyleties are recorded. But periosteal stripping followed by calcification forming bony swelling is not recorded. The author tries to emphasis the even though at the time of presentation there was no clinical evidence of bone injury, periosteal reaction can lead to a similar phenomenon of exostosis in such injuries. CORRESPONDENCE TO Mr. Zakir Shariff, 23, Rosemary Way, Beverly. HU17 0SS. UK Phone: 07793538278 Email : zakirshariff@hotmail.com References 1. Fourie L, Cartilidge D: Fracture of the maxilla following dog bite to the face, Injury. 1995 Jan;26(1):61-2. 2. Desai SS, Groves RJ, Glew R: Subacute Pasteurella osteomyelitis of the hand following dog bite.Orthopedics. 1990 Jun;13(6):653-6 3. Goldstein EJC: Bite wounds and infection. Clin Infect Dis 1992, 14:633-640 4. Hoff GL, Cai J, Kendrick R, Archer R: Emergency department visits and hospitalizations resulting from dog bites, Kansas City, MO, 1998-2002.Mo Med. 2005 Nov- Dec;102(6):565-8 5. Akhtar N, Smith MJ, McKirdy S, Page RE: Surgical delay in the management of dog bite injuries in children, does it increase the risk of infection?, Br J Plast Surg. 2005 Sep 8; Rare Case Of Exostosis Following Dog Bite: A Case Report 3 of 3 Author Information Zakir Shariff, MS, MRCSEd SHO, Plastic Surgery, Lancashire Teaching Hospital John Giannas, FRCS Specialist Registrar, Plastic Surgery, Lancashire Teaching Hospital J. Srinivasan Consultant, Plastic Surgery, Lancashire Teaching Hospital