Creation of Single-Bone Forearm in Case of Diffuse Chronic Osteomyelitis of Diaphysis of Radius in an Adolescent Treated with Two Staged Procedure: A Case Report.

Abstract

Introduction: Chronic osteomyelitis is a debilitating bone infection that can lead to significant morbidity and functional impairment. This condition is often challenging to treat due to its complex nature and the ability of bacteria to form biofilms, which make them resistant to antibiotics. Early diagnosis and a multidisciplinary approach are crucial for successful management. Orthopedic surgeons often encounter chronic osteomyelitis as a difficult and persistent problem. The key to effective treatment lies in prompt diagnosis and a combination of surgical intervention and antimicrobial therapy. In cases of extensive bone loss or complex infections, a multidisciplinary team, including infectious disease specialists and plastic surgeons, may be necessary to optimize patient outcomes. Isolated involvement of the radius shaft is an uncommon presentation of chronic osteomyelitis.

Case report: A 13-year-old male presented with persistent pain, deformity, and multiple draining sinuses on his right forearm. Radiographic imaging confirmed the diagnosis of diffuse chronic osteomyelitis. A two-stage treatment approach was employed to address the infection and restore bone integrity. The first stage involved aggressive debridement of infected tissue, implantation of antibiotic-coated bone cement to deliver sustained drug levels, and stabilization of the fracture using Joshi's External Stabilizing System (JESS). The second stage focused on removing the antibiotic-coated bone cement once the infection was controlled and centralizing the ulna to improve forearm alignment and function.

Conclusion: This case highlights the importance of a tailored treatment approach for chronic osteomyelitis. Early intervention, aggressive debridement, appropriate antibiotic therapy, and surgical stabilization are essential components of successful management. In complex cases, a multidisciplinary team can provide optimal care and improve patient outcomes.