[Chronic osteomyelitis of the clavicle]

Chronic Osteomyelitis of Clavicle in a Neonate: Report of Morbid Complication of Adjoining MRSA Abscess

Osteomyelitis of clavicle is rare in neonates. Acute osteomyelitis of clavicle accounts for less than 3% of all osteomyelitis cases. It may occur due to contiguous spread, due to hematogenous spread, or secondary to subclavian catheterization. Chronic osteomyelitis may occur as a complication of residual adjoining abscess due to methicillin resistant staphylococcus aureus (MRSA) sepsis. We report a newborn female with right shoulder abscess that developed chronic clavicular osteomyelitis in follow-up period after drainage. She required multiple drainage procedures and was later successfully managed with bone curettage and debridement. We report this case to highlight that a MRSA abscess may recur due to residual infection from a chronic osteomyelitis sinus. It may be misdiagnosed as hypergranulation tissue of nonhealing wound leading to inappropriate delay in treatment. High index of suspicion, aggressive initial management, and regular follow-up are imperative to prevent this morbid complication.

[Osteomyelitis in children]

Acute hematogenous osteomyelitis is a typical childhood illness, occurring predominantly in boys. The main symptom is inflammation but poor general condition also occurs occasionally. Elevation of CRP and sedimentation rate as well as leucocytosis are the most important laboratory findings. Conventional x-ray is mandatory, however scintigram and MRI are now specific in the early stage. Ultrasound can show abscess formation in the soft tissue. Treatment involves the immediate use of specifically targeted, intravenous antibiotics. Surgical intervention stands in second place. Immobilisation is only useful in the initial treatment of pain. Strict diagnostic and therapeutic management prevents complications, which would need reconstructive bone and soft tissue reconstruction, and is the key to a good primary prognosis.