J Korean Fract Soc.  2016 Oct;29(4):270-275. 10.12671/jkfs.2016.29.4.270.

Acute Patellar Osteomyelitis in a Child after a Blunt Trauma: Case Report

• Chung HJ
• Kim DS
• Yeom JS
• Jang YH

• KMID: 2355433
• DOI: http://doi.org/10.12671/jkfs.2016.29.4.270

Abstract

Osteomyelitis of the patella is a very uncommon condition that occurs mostly in the pediatric population. In addition to its rarity, nonspecific and variable clinical presentations usually lead to postponement in making the correct diagnosis. Moreover, it is often missed as prepatellar bursitis or septic arthritis of the knee. Nonetheless making early diagnosis and initiating prompt treatment is most important to preventing this condition from becoming chronic. In this case report, the authors encountered this rare condition of the patella in a child that was first misdiagnosed with pyogenic arthritis or prepatellar bursitis of the knee. The delay in making the diagnosis led to intractable progression of the disease, and sequestrectomy was required to stabilize the condition.

Keyword

Patella; Osteomyelitis; Trauma

MeSH Terms

Arthritis
Arthritis, Infectious
Bursitis
Child*
Diagnosis
Early Diagnosis
Humans
Knee
Osteomyelitis*
Patella

Figure

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  Fig. 1 Simple radiographies of anteroposterior (A), lateral (B), and skyline (C) views of the knee revealed insignificant findings except for soft tissue swelling in the right knee.

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  Fig. 2 During first operation, midpatellar incision was made over the patella, and there was collection of pus in the prepatellar area.

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  Fig. 3 Axial (A), coronal (B), and sagittal (C) views of magnetic resonance imaging taken a few days after the first operation revealed joint effusion, wide infiltration of subcutaneous tissue and osteolytic lesion with sequestration that was communicating with the prepatellar bursa. There were no remarkable pathologic signals in the femur or tibia and no evidence of direct connection of subcutaneous lesions with intraarticular space.

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  Fig. 4 During the second operation, it was noted that there was a sinus connected the area of a dehiscence wound to the prepatellar bursa.

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  Fig. 5 A hole was found on the anterior aspect of the patella that was directly communicating with the prepatellar bursa.

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  Fig. 6 Latest follow-up plain radiography (7 months post-operation day). Anteroposterior (A), lateral (B) view revealed osteolytic changes in patella. There were no significant findings for the femur, tibia and knee joint space.

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