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* C. Dieme, A. Sane,
A. Dansokho, I. Keita, A. Ndiaye, S. Seye
*Orthopaedic – traumatology,
A. Le Dantec Hospital Dakar Sénégal
Address for Correspondence
Dr Charles Dieme,
P O Box: 25.702 Dakar Sénégal.
Email : cbdieme@yahoo.fr |
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Abstract
The authors report a
chronic case of osteomyelitis in its sequestering and sitting
exteriorized form to the level of the clavicle. This
observation is original because of the scarcity of this form and
the seat of the lesion. The pathogenesis of osteomyelitis is
pointed out. The easy diagnosis is evoked, just as the absence
of functional repercussion after sequestrectomy without minor
surgical gesture.
J.Orthopaedics 2006;3(1)e8
Introduction:
Chronic osteomyelitis constitutes the result
of the unfavourable evolution of the acute form. It sits in
general at the long bones and can cover several aspects. But it
is often characterized by an osseous sequestration at the origin
of cutaneous fistula, acute alarm clocks and pathological
fractures [ 2 ]. We describe the observation concerning a
teenager who presents an exteriorized sequestering form, sitting
on the level of the clavicle.
Case Report:
Mr. D. 16 years old
consulted for an osseous projection exteriorized on the level of
the average third of the right clavicle. The examination showed
that the projection developed with depends on the clavicle with
an aspect on necroses osseous and a nauseant odor (fig. 1). In
addition, there was a cutaneous depression under the osseous
projection with loss of not very significant substance. The
interrogation has revealed the appearance of a painful
symptomatology for approximately 3 years with concept of a
productive dent repeating during the evolution. No modern
treatment had been undertaken. The radiography of the clavicle
did not show a loss of osseous substance. The osseous
continuity of the clavicle was present with hypercondensation at
the average third
(fig. 2). Biological
examinations: numeration formulates blood, sedimentation test
and C Reactive Protein were normal. The search for an etiology
tubercular patient and syphilitic was negative. The chronic
diagnosis of osteomyelitis of the clavicle in its exteriorized
sequestering form was retained. The ablation of the
exteriorized sequestration was carried out easily without
anaesthesia by means of a grip with sequestration. The
continuations were simple. Cutaneous closing under the
sequestration was carried out spontaneously.
Discussion :
Osteomyelitis gather all
the infections of the bone and marrow by hematogen way. The
passage to the chronic form is the result of the unfavourable
evolution of acute osteomyelitis [ 3 ]. Nevertheless, certain
authors described chronic forms from the start [ 4,5 ].
However, the development made by Essadam made it possible to
better include/understand pathogenesis [ 6 ]. It defines
osteomyelitis as a process of devascularisation of the
periosteal and endosteal arterial system secondary in 2
mechanisms of the infection: the thrombophlébitis and the
infection. In the absence of an early diagnosis and an adapted
treatment, the result of this process is necroses it bone. This
necroses can evolve to the resorption of the mortified zone or
its detachment with constitution of sequestrations.
The sequestrations of
small size are generally included or evacuated spontaneously by
a cutaneous dent. On the other hand, the sequestrations of big
size generally require a surgical evacuation. At our patient,
exceptional fact, the sequestration was expressed in spite of
its big size, making thus useless a surgical gesture
(trepanation of the bone). This exteriorisation of the
sequestration is the consequence of a diagnostic delay and
absence of an adapted treatment. In the field of the
localization, the osteomyelitis of the clavicle is rare [ 7 ].
It generally occurs by infection of vicinity after surgery of
the head and the neck [ 8, 9 ]. Other modes of contamination of
the clavicle were described after catheterization of the known
vessels keyboards [ 10 ], [ 11 ], [ 12 ]. In our case, it east
is about the unfavourable evolution of an acute osteomyelitis.
In the diagnostic plan, the osteomyelitis of the clavicle can
make evoke the etiology tubercular patient, syphilitic. But
their research was unfruitful. This affection can also enter
within the framework of the SAPHO syndrome which associates a
whole of ostéo-articular attacks cutaneous demonstrations [ 13,
14, 15 ]. In the forecast plan, no functional repercussion was
noted at our patient. The involucrum completely reconstituted
the clavicle without any loss of osseous substance. It is
besides to recommend to carry out the ablation of the
sequestration after a development proportional of the involucrum
[ 16 ].
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