Post-Fracture Pain: Signs of Chronic Osteomyelitis?

After a fibula fracture has healed, there may occasionally be a sudden sharp pain?

In mid-October 2017, I had the steel pins removed from a previous fibula closed fracture.
At the end of October, the staples used to secure the wound were removed.
On November 2, the wound was red, swollen, hot, and painful.
On the evening of November 4, when I removed the dressing, I found that the wound had opened up and there was a thick, cloudy pus.
I went to the hospital, and the doctor prescribed me cephalexin capsules 500 mg.
By November 8, the redness and swelling of the wound continued to increase.
Due to work requirements, I had to wear rain boots, which put pressure on the area, and eventually, the wound burst open, releasing a significant amount of black pus mixed with blood.
I also discovered surgical sutures in the wound, which may have been rejected due to my weakened immune system at that time.
After removing the sutures, the wound healed rapidly.
The area where the steel pins were removed felt like it had abnormal bone growth.
However, in mid-December, I experienced intermittent sharp pains in my foot, similar to being quickly pricked with a needle.
This has severely impacted my life and mood, making me irritable.

Could I have signs of chronic osteomyelitis? What tests are the most reliable and accurate to determine if I have osteomyelitis? I am also willing to consider out-of-pocket options, as I am feeling exhausted.
Currently, I am abroad and uncertain whether to return to my home country.

Yuzhi, 20~29 year old female. Ask Date: 2018/01/29

Dr. Li Yongheng reply Orthopedics

Hello, based on your symptoms, it is possible that you have a superficial wound infection with a stitch abscess.
Generally speaking, if the wound has healed, it indicates that the infection is under control.
The likelihood of chronic osteomyelitis is low, and a nuclear medicine osteomyelitis scan can be used for evaluation.
Currently, if there are no obvious signs of redness, swelling, heat, pain, or purulent discharge, you may continue to monitor the situation.
However, if you are feeling exhausted and under significant stress, it would be advisable to return to your home country for an examination.
Wishing you a speedy recovery.

Reply Date: 2018/01/29

More Info

Based on your detailed description of your symptoms and medical history following your fibula fracture, it is understandable to be concerned about the possibility of chronic osteomyelitis. Chronic osteomyelitis is a persistent bone infection that can occur after a fracture or surgical procedure, particularly if there were complications such as wound infections or the presence of foreign materials like surgical sutures or hardware.

From your account, it appears that you experienced a series of complications post-surgery, including significant swelling, redness, and the presence of purulent discharge from the wound. These symptoms are indicative of an infection, and the fact that you had to deal with a foreign body (the surgical sutures) could have contributed to your immune response and the subsequent complications. The black pus you described could suggest necrotic tissue or an ongoing infection, which is concerning.

The intermittent sharp pains you are experiencing in your foot could be a sign of several conditions, including nerve irritation, complex regional pain syndrome (CRPS), or even chronic pain related to the previous injury. While these symptoms can be distressing and impact your quality of life, they do not definitively indicate chronic osteomyelitis.

To determine whether you have chronic osteomyelitis, several diagnostic tests can be performed:
1. Imaging Studies: An MRI or a CT scan can provide detailed images of the bone and surrounding tissues, helping to identify any signs of infection or bone changes associated with osteomyelitis. MRI is particularly sensitive to changes in bone marrow and soft tissue.

2. Bone Scintigraphy: A nuclear medicine scan can help detect areas of infection or inflammation in the bone. This test can be particularly useful if the infection is not easily visible on standard X-rays.

3. Blood Tests: While your ESR and CRP levels were normal, which typically indicates no active inflammation, these tests can sometimes be elevated in cases of osteomyelitis. However, normal levels do not rule out the condition.

4. Bone Biopsy: If imaging studies suggest osteomyelitis, a biopsy may be performed to obtain a sample of the bone for culture and sensitivity testing. This is the most definitive way to diagnose osteomyelitis.

Given your symptoms and the impact they have on your daily life, it would be prudent to consult with an orthopedic specialist or a physician experienced in infectious diseases. They can guide you through the necessary tests and help determine the best course of action. If you are currently abroad and feeling overwhelmed, it may be beneficial to return to your home country for further evaluation and treatment, especially if you have access to healthcare providers who are familiar with your medical history.

In summary, while your symptoms could suggest chronic osteomyelitis, further diagnostic testing is essential to confirm the diagnosis. It is important to address these concerns promptly to prevent any potential long-term complications. Your health and well-being should be the priority, and seeking appropriate medical care is crucial.

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