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Abstract: The patient is a 65-year-old male with a past history of diabetes mellitus. Due to poor glycemic control, impaired peripheral circulation occurred and bacteria invaded the toe, forming a purulent infection that led to inflammation of the bone marrow, causing local redness, swelling, heat, pain, and other inflammatory reactions, and radiographs were taken to confirm osteomyelitis. It is recommended that the patient be hospitalized in a timely manner, and that debridement surgery be used, together with later bone grafting treatment, to cure the osteomyelitis and resume weight-bearing walking on the affected foot.
Basic information】Male, 65 years old
Disease Type】Osteomyelitis
Hospital】Harbin First Hospital
Date of consultation】October 2021
Treatment plan】Cancellation + bone grafting + local braking + blood sugar control
Treatment Period】7 days of inpatient treatment, 1 month of outpatient review
Results】The inflammation of bone marrow was cured, and the foot resumed weight-bearing walking.
I. Initial consultation
The patient came to our hospital in October 2021, reporting localized pain and swelling in the toe, along with generalized fever. After a detailed history, we learned that the patient had a history of diabetes mellitus for many years and had poor glycemic control. We considered that it might be osteomyelitis, but we could not be sure, so we asked the patient to undergo an X-ray examination, and the results suggested that osteomyelitis had formed at the end of the bunion. Based on the patient’s medical history and examination results, it was considered that the osteomyelitis was caused by years of diabetes mellitus, resulting in obstruction of the peripheral blood vessels, ischemic necrosis of the local soft tissues, and secondary infection involving the bones.
II. Treatment
The patient’s condition is relatively serious, and conservative treatment may aggravate the condition and even make it impossible to preserve the length of the bunion and the function of the bunion. It is recommended to perform debridement surgery after active preoperative treatment to remove the infected lesion and avoid more serious sepsis. Postoperative treatment with braking therapy, blood sugar control, and second-stage surgical implant treatment to preserve the length of the end of the bunion as much as possible can gradually restore normal walking function. After careful consideration, the patient and his family opted for surgical treatment. During the debridement process, dead bone formation and local pus flow were found in the affected area, and the dead bone and inflammatory granulation tissue were removed, the dead cavity was repeatedly flushed to eliminate the dead cavity, and the bone defect site was filled. The filling was removed 2 weeks after surgery, and bone grafting was performed, i.e., the wound was closed after implantation of autologous bone cancellous. During this period, the patient was asked to brake the affected limb and strictly control blood sugar, and the patient actively cooperated.
III. Treatment effect
The bunion end-joint osteomyelitis lesion was completely removed through debridement surgery, and no infection occurred. After the osteotomy, the patient’s bony strength and weight-bearing function of the end phalanx of the bunion were gradually restored, so that daily life could be ensured. After surgical treatment, the patient’s local pain symptoms and pus flow disappeared, the blood circulation of the toe skin was gradually restored, and the body temperature dropped to a normal level. Seven days after admission, the patient recovered well and gradually resumed his activities, and was discharged from the hospital. Before discharge, the patient was asked to come to the outpatient clinic for a review in one month.
IV. Notes
We are glad that the patient was able to preserve the original length of the toe and remove the infected lesion after the debridement and bone grafting surgery. After discharge from the hospital, the patient needs to pay attention to the fact that due to the relatively long treatment period, strict control of blood sugar is needed during the recovery phase to avoid high blood sugar or drastic blood sugar fluctuations, which may affect the healing of the surgical wound. At the same time, they should move their limbs and joints properly in bed to speed up blood circulation and promote the repair of surgical wounds. In ordinary life, patients need to avoid trauma to the toes, and if local redness and swelling occur, they should follow up with the orthopedic clinic in a timely manner for early treatment to avoid the formation of septic infection leading to osteomyelitis again.
V. Personal insight
The patient’s septic infection formed osteomyelitis, which destroyed the toe and caused localized dead bone, and if left untreated, she would eventually face toe amputation. In this case, the patient’s persistent unstable blood sugar and poor physical condition are the main reasons for this situation. In daily life, patients should raise their health awareness and always keep their blood glucose stable, and also pay attention to protecting their toes from injuries such as smash and crush injuries. In case of trauma, it is important to visit orthopedics in a timely manner.