First case

Dr Etienne, who is one of the orthopaedic trainees at Justinien Hospital, has sent me a photo of a young child with chronic osteomyelitis of the tibia. Apparently the infection has been going on for the last 5 months and it is clear from the photo that most of the leg bone has died .

Large sequestrum of the tibia

 This will require surgery to remove the dead bone and immobilisation of the leg (plaster or external fixator) until the new bone formed by the periosteum (tissue surrounding normal bone) is strong enough to allow this child to walk again. Normally an Xray would show the extend of the bone regeneration. Once the dead bone has been removed the skin will normally close over and if necessary a skin graft can be carried out. Secondary bone grafting is sometimes required once the skin is healed and the infection treated.

I guess I will see this young boy on the ward next week.