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How to manage bone infection after fracture of the leg bone?

Q: I am a 57 years male. I met with a motor cycle accident 3 years back and my bone two inches below the left knee was fractured. A surgery was performed, and bone was fixed using two plates and bolts. Subsequently, infection developed at the surgical wound. After about 8 months the plates were removed and another equipment consisting of three rings interconnected with steel rods were used to complete the bondage of fractured part. After 7 months, since the union was not complete, the left leg was plastered for six months. Now I am about 98% ok, but the infection persists even after three years. Incidentally I am a diabetic. During the course of treatment, several cultures were done and antibiotics taken but without any positive result. Last month, when I met my orthopaedic consultant, he suggested that there could still be some particles of bone and another surgery may be required to remove such particles after identifying them by X-Ray. I would like to have your opininon on this matter.

A:From your description you seem to be a case of chronic osteomyelitis of your leg bone. It is very common for such patients to have persistent discharge from the infected side for some time. It is easy to differentiate dead bones on the X-ray but at times it is very difficult. If it is visible on the X-ray, surgery is easy. If, however, it is not visible on the X-ray, surgery is risky as we may take out more bone than necessary thereby weakening the bone with a subsequent risk of fracture. There is no point in taking antibodies unless you have systemic evidence of sepsis. Usually this manifests as fever. If the treating doctor is sure about the bone abscess and you are confident on his competence, I think it is safe to go ahead and get the surgery done. One word of caution: once there is infection in the bone, no one can assure you that they can permanently cure the infection. Therefore be aware that there is always a possibility of recurrence of infection.

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