Acute on Chronic Osteomyelitis of the Humerus – A Case Report on a Neglected Case of Chronic Osteomyelitis with Bone Cement In Situ

INTRODUCTION: Chronic osteomyelitis is the bane of orthopedics. Along with being difficult to treat for surgeons, it also impacts the patient’s life immensely, severely restricting their life in all the aspects. Treatment with antibiotic coated cement spacers, which are removed after a duration of 6–8 weeks for the definitive surgery, is a frequently done procedure in conjunction with an adequate debridement of the necrotic tissues and prolonged IV antibiotics. We report a case of acute osteomyelitis superimposed on the chronic osteomyelitis of the left proximal humerus. CASE PRESENTATION: An immunocompetent and otherwise healthy 14-year old Indian male who was operated 1 year ago for chronic osteomyelitis presented to us with an acute tense swelling, unbearable pain, and toxemia, with a cement spacer and multiple cement beads in situ. With regards to his initial injury, he had history of fall from height with a puncture wound, possible humerus fracture, treatment by local healers as well as surgical procedures in an outside facility with debridement and placement of cements spacer and beads. On presentation to our facility, removal of retained cement plus debridement was carried out, and after serial surgeries, the defect was successfully treated with the use of antibiotic loaded absorbable calcium sulfate. CONCLUSION: A basic knowledge about the ideal practices for taking treatment is still inadequate in many population groups within India . It is important to spread awareness of proper healthcare seeking practices among people so that the disability associated time and loss of activity related to injury is significantly reduced. Furthermore, calcium sulfate can be an effective option for treatment of bone defects associated with chronic osteomyelitis.