Chronic Osteomyelitis of Proximal Tibia Due To A Retained Glove Piece: A Case Report

Volume 8 | Issue 1 | Jan – Feb 2020 | Page: 30-33  | Sujayendra D M, Mahesh S Kulkarni, Aditya Mukadam, Sharath K Rao


Authors: Sujayendra D M [1], Mahesh S Kulkarni [1], Aditya Mukadam [1], Sharath K Rao [1]

[1] Department of Orthopaedics, Kasturba Medical College, MAHE, Manipal, India.

Address of Correspondence
Dr. Sujayendra D M,
Kasturba Medical College, MAHE, Manipal, India.
E-mail: sujayendra16@gmail.com


Abstract

Introduction: The classic presentation of chronic osteomyelitis is characterized clinically by the presence of a draining sinus, and radiologically by sequestrum. Despite adequate treatment when the sinus fails to heal, one has to evaluate for its persistence. The presence of sequestrum and foreign body is one of the common causes for failure of the treatment. Except for one report, there are no described cases in the literature, where the surgeon’s glove piece has been left inside a bone and caused osteomyelitis. We are reporting a case of chronic osteomyelitis of tibia due to a retained glove piece following surgical management of proximal tibia fracture.
Case Report: A 36-year year-old male, with nil pre-morbid conditions, presented with complaints of discharging sinus from the anterior aspect of the proximal part of the left leg since for 2.5 years. He had undergone implant removal for sinus discharge following healed proximal tibial fracture which was managed with open reduction and internal fixation. Radiological evaluation revealed a cavity with sequestrum. During planned debridement and sequestrectomy, one surgical glove piece was as well retrieved from the cavity. Pseudomonas aeruginosa was isolated and he received appropriate antibiotic therapy. The patient after the procedure improved and during the last past one 1 year of follow-up, there is no recurrence of discharge and sinus has healed.
Conclusion: Chronic osteomyelitis is a debilitating condition. All precautions are to be taken to prevent osteomyelitis while performing orthopaedic surgeries, more so while dealing with closed fractures. A high index of suspicion of foreign body retention is suggested while evaluating these cases,.While while performing procedures that involve instrumentation with sharp objects, one must regularly inspect and if the need be, replace the gloves regularly.
Keywords: Chronic osteomyelitis, Foreign body, Glove perforation, Fracture complication, Non-healing sinus, Infection.


References

1. ParsonsB, StraussE. Surgical management of chronic osteomyelitis.Am J Surg2004;188:57-66.
2. Radcliffe G. Osteomyelitis: A historical and basic sciences review. Orthop Trauma 2015;29:243-52.
3. WalterG, KemmererM, KapplerC, HoffmannR. Treatment algorithms for chronic osteomyelitis.DtschArzteblInt2012;109:257-64.
4. GitelisS, BrebachGT. The treatment of chronic osteomyelitis with a biodegradable antibiotic-impregnated implant.J OrthopSurg (Hong Kong)2002;10:53-60.
5. CiampoliniJ, HardingKG. Pathophysiology of chronic bacterial osteomyelitis. Why do antibiotics fail so often?Postgrad Med J2000;76:479-83.
6. JohnstonBR, HaAY, KwanD. Surgical management of chronic wounds.R I Med J (2013)2016;99:30-3.
7. AgarwalA, AgarwalS. Retained foreign body masquerading as chronic osteomyelitis: A series of 3 cases and literature review.J ClinOrthop Trauma2019;10:816-21.
8. LiawF, MurrayO, TanYY, HemsT. Retained foreign body in a diabetic patient’s hand.Open Orthop J2018;12:203-7.
9. VidyadharaS, RaoSK. Thorn prick osteomyelitis of the foot in barefoot walkers: A report of four cases.J OrthopSurg (Hong Kong)2006;14:222-4.
10. ChandrashekaraCM, GeorgeMA, Al-MarboiBS. Neglected foreign body, the cause of navicular osteomyelitis in a paediatric foot: A case report.J Orthop Case Rep2013;3:26-9.
11. ChangHC, VerhoevenW, ChayWM. Rubber foreign bodies in puncture wounds of the foot in patients wearing rubber-soled shoes.Foot Ankle Int2001;22:409-14.
12. SidharthanS, MbakoAN. Pitfalls in diagnosis and problems in extraction of retained wooden foreign bodies in the foot.Foot Ankle Surg2010;16:e18-20.
13. SivakumarR, SinghiPK, ChidambaramM, SomashekarV, ThangamaniV. A sub-acute septic arthritis of the knee; a sequelae to thorn prick injury of patella: A case report.J Orthop Case Rep2016;6:100-3.
14. MeurerWJ. Radial artery pseudoaneurysm caused by occult retained glass from a hand laceration.PediatrEmerg Care2009;25:255-7.
15. SurovA, ThermannF, BehrmannC, SpielmannRP, KornhuberM. Late sequelae of retained foreign bodies after World War II missile injuries.Injury2012;43:1614-6.
16. Imoisili M, Bonwit A, Bulas D. Toothpick puncture injuries of the foot in children. Pediatr Infect Dis J 2004;23:80-2.
17. Sadat-AliM, MarwahS, al-HabdanI. Retained portion of latex glove during femoral nailing. Case report.Indian J Med Sci1996;50:308-9.
18. González-ReimersE, Trujillo-MederosA, OrdóñezAC, Arnay-da-la-RosaM. A case of calcaneal osteomyelitis from the prehispanic population of El Hierro (Canary Islands).Int J Paleopathol2015;8:36-41.
19. WebbLX, HolmanJ, deAraujo B, ZaccaroDJ, GordonES. Antibiotic resistance in staphylococci adherent to cortical bone.J Orthop Trauma1994;8:28-33.
20. RovereGD, MatternML. Hemidiaphysectomy to control chronic osteomyelitis.South Med J1978;71:874-7.
21. SchneiderT, RenneyJ, HaymanJ. Angiosarcoma occurring with chronic osteomyelitis and residual foreign material: Case report of a late World War II wound complication.Aust N Z J Surg1997;67:576-8.
22. AggarwalAN, KiniSG, AroraA, SinghAP, GuptaS, GulatiD. Rubber band syndrome-high accuracy of clinical diagnosis.J PediatrOrthop2010;30:e1-4.
23. MaffulliN, CapassoG, TestaV. Glove perforation in elective orthopedic surgery.ActaOrthopScand1989;60:565-6.
24. LakomkinN, CruzAI Jr., FabricantPD, GeorgiadisAG, LawrenceJT. Glove perforation in orthopaedics: Probability of tearing gloves during high-risk events in trauma surgery.J Orthop Trauma2018;32:474-9.
25. MisteliH, WeberWP, ReckS, RosenthalR, ZwahlenM, FueglistalerP, et al. Surgical glove perforation and the risk of surgical site infection.Arch Surg2009;144:553-8.
26. HarnossJC, ParteckeLI, HeideckeCD, HübnerNO, KramerA, AssadianO. Concentration of bacteria passing through puncture holes in surgical gloves.Am J Infect Control2010;38:154-8.
27. EidelmanM, BialikV, MillerY, KassisI. Plantar puncture wounds in children: Analysis of 80 hospitalized patients and late sequelae.Isr Med Assoc J2003;5:268-71.
28. ElBouchti I, AitEssi F, AbkariI, LatifiM, ElHassani S. Foreign body granuloma: A diagnosis not to forget.Case Rep Orthop2012;2012:439836.
29. DeSmet L. Metallosis mimicking osteomyelitis from a forearm plate retained for 50 years.ActaOrthopBelg2000;66:289-91.


How to Cite this article: Sujayendra D M, Kulkarni M , Aditya Mukadam A, Rao S | Chronic Osteomyelitis of Proximal Tibia Due To A Retained Glove Piece: A Case Report | Journal Of Karnataka Orthopaedic Association | Jan-Feb 2020; 8(1): 30-33.

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