Delayed post-traumatic presentation of severe sternal osteomyelitis: A strong multidisciplinary effort and a novel reconstruction technique for a challenging case. | LitMetric
Sternal osteomyelitis is a morbid and challenging condition, which can rarely occur after trauma, with no established consensus over best therapeutic options. In this case, a 47-year-old man with history of intravenous drug use presented 11 weeks after a minor blunt chest trauma with a severe necrotizing osteomyelitis involving sternum, muscles, fascia and subcutaneous tissue and positive blood cultures for Methicillin Sensitive . Alongside tailored antibiotic therapy, extensive surgical debridement was performed, leaving a full thickness 3 × 4 cm sternal defect and a large skin defect. After 4 weeks of antibiotics and Vacuum-Assisted-Closure pump, a novel reconstruction technique was utilized, with full collaborations of thoracic surgeons, orthopaedic surgeons and plastic surgeons. An autologous tricortical iliac crest bone graft was harvested and shaped to fit the full-thickness sternal defect, while two titanium sigmoid-shaped clavicle plates were used for internal fixation of the autograft. The large skin defect was covered with a pedicled myocutaneous latissimus dorsi flap. Integrity and stability of the chest wall was fully restored, and infection was completely eradicated. No complications occurred and the patient was well at the 18 months follow-up. To the best of our knowledge, this is the first report on autologous iliac crest bone graft in the treatment of sternal osteomyelitis. In this case, it proved to be a viable therapeutic option, providing good long-term clinical and cosmetic results.
A 67-year-old female presented to the emergency department after falling on her chest. On initial presentation, her chest wall was tender to palpation with mild overlying ecchymosis. Initial imaging demonstrated a sternal body fracture with minimal retrosternal hematoma.
Tuberculosis Spondylitis, also known as Pott's Disease, is an extrapulmonary form of tuberculosis (TB) that affects the spine. Sternal involvement is rare and accounts for only 0.3 % of cases.
Sternal tuberculosis (TB) is a rare extrapulmonary manifestation of TB that usually manifests with nonspecific symptoms. Timely diagnosis and intervention are essential to avoid complications. Here, we discuss a case involving a 46-year-old male who experienced right scapular pain for six months and sternal swelling for 11 months.
: is an uncommon pathogen that has been reported to infect musculoskeletal structures. However, studies are largely limited to case reports, and little is known regarding management and outcomes of these infections. : We performed a multicenter retrospective cohort study of adults with culture-confirmed musculoskeletal infections at three Mayo Clinic centers in Arizona, Florida, and Minnesota from November 2011 through April 2022.
A 54-year-old man with a history of atopic dermatitis was admitted to our hospital for persistent fever and multiple arthralgias unresponsive to antibiotics. On the second day of hospitalization, Staphylococcus aureus was detected in the blood culture, and debridement for presumed pyogenic arthritis was performed on the patient's bilateral wrists and right ankle joints. Echocardiography showed evidence of infective endocarditis of the aortic valve.
