Orthopedics - Oleksa A.P. 2006

Osteomyelitis
Litre's osteomyelitis

Albuminous Osteomyelitis is named after the author who first described it. This form of osteomyelitis is extremely rare and most frequently localizes periosteally in the Femur or Tibia. Patients seek medical attention due to vague pain and soft tissue pastosity over the affected bone, which is clearly visible on the lower leg. The Skin retains its normal color. Palpation may occasionally reveal a nearly painless fluctuation. As a rule, Blood Laboratory tests indicate deviations from normal parameters.

Radiologically, pathological bone changes are almost never detected, as the process occurs beneath the periosteum. The periosteum is stripped from the bone by a distinctive serous, sticky, and viscous exudate rich in albumins.

The Diagnosis is typically confirmed during surgery.

Over many years of clinical practice, we have had to operate on only one patient with albuminous osteomyelitis of the tibia.

Following a linear incision along the planum tibiae, a small amount of nearly transparent, sticky, viscous exudate was released from underneath and sent for bacteriological culture and Cytology. The periosteum was stripped by the exudate over a length of 6 cm. Shallow (up to 1-2 mm) grooves, uneven and branching in various directions, were visible in the cortical layer on the planum os tibiae. For better bone access, the periosteum was cross-sectioned and retracted. Using a sharp osteotome, the affected surface of the cortical layer was excised within healthy bone limits. The bone surface and periosteum were repeatedly irrigated with a 1:5000 furacilin solution and dried. The periosteum was adapted and the wound was closed in layers. For a week post-surgery, the patient received antibiotic therapy.

Bacteriological examination yielded no microflora growth, and cytologic analysis revealed no cellular elements other than sporadic leukocytes.

The postoperative wound healed by primary intention. The patient was satisfied with the Treatment and, throughout 10 years of follow-up, considered himself healthy.