The case of the patient with the new leg

While I was in Africa, I encountered numerous medical problems I had never experienced in the states-some of which I will document here in the coming days. The case of the patient with the new leg is a little different though. Let's start with a picture.

This wound is about 3-4 cm across and was draining foul smelling discharge. The patient had been seen at other hospitals for this in other villages and they thought he had a skin abscess and would heal over time with some antibiotics. The abscess wasn't healing though and it had been going on for a few months so they were brought to the Maseno Mission outpatient clinic.
He was seen by Francis, one of our clinic officers and admitted to be started on antibiotics. We x-rayed his leg and found this.


That's his femur on the right-and that's not normal.

Here's a normal right femur for comparison


Notice on the normal femur it is thin and rod-like and has a demarkation between the outer bone (compact bone) and inner bone (spongy bone)? That's all missing on the xray of the patient I saw.

This condition is called chronic osteomyelitis in the United States and it's very very common. We see numerous elderly patients, generally with diabetes or peripheral vascular disease. It is a very hard to treat illness and antibiotics are given over several months and it's not always possible to eradicate it. Many times, amputation is the only way to control it. It's caused by a bacteria (usually staph aureus, but other bacteria can cause it too. Over time, the infection in the bone causes an influx of inflammatory cells that can kill the bone (or necrotize) as they try to kill off the infection. Sometimes even new bone is made as is in the case of the patient above-his body trying to make up for the dead bone made the strange shaped leg you see above.

The real shocker comes when you see what this patient looked like though.

This was not old person with diabetes, or decubitus ulcers, or paralysis.



This was a happy, smiling 4 year old boy!

He probably had trauma to that leg some time before and the infection was never properly handled and continued to worsen-killing off his bone and causing him bone pain. Eventually the infection even formed a sinus tract (the "abscess") to his skin. Amazingly enough, the boy walked with relatively little dysfunction. We ended up treating him with a few days of antibiotics and after his fever went down, sent him home with several months of antibiotic pills. He was one of the happiest patients I had though-where other kids his age were very shy or would cry when a white coat would come by-he would always smile for me. I really hope he gets better and doesn't have to have his leg amputated.

Hard Lessons in Swahili

Actually this was true for this patient-but why it was in a translation book for kids is anyone's guess

Ana mguu mmoja mfupi kuliko mwingine

He has one short leg than the other