Peninah B., 18

Penninah is an 18-year-old girl who lives with her mother in a remote area. Following a divorce, her mother became the sole provider for the family. She supports the household through a small-scale business that earns less than 2,500 shillings per month, which is not enough to meet basic needs such as food, shelter, and healthcare. As a result, the family continues to face serious financial hardship. Recently, Penninah sustained a serious injury resulting in an open fracture of the left tibia. The condition requires urgent medical care, including surgery, medication, and continuous follow-up. Unfortunately, due to their financial limitations, her mother is unable to meet the costs of hospital treatment. Penninah first underwent surgical debridement and external fixation with metallic implants several months earlier after the injury. The procedure had been carried out by visiting orthopedic surgeons at a public hospital. Although she initially stabilized after surgery, she later began experiencing persistent pain and delayed healing at the site of the operation. In the weeks leading up to her recent hospital visit, Penninah developed worsening pain in the mid-shaft of the left leg, especially when walking or putting weight on the limb. She also noticed swelling around the surgical area, along with occasional low-grade fevers and increasing tenderness near the implant site. She reported no new injury. A local examination of the left leg showed a healed but firm surgical scar along the anterior tibia. There was localized swelling, warmth, and significant tenderness in the mid-tibial region where the implant was located. The metal hardware was palpable and prominent beneath the skin, with mild redness around the area. There was also purulent discharge observed during the examination, and deep palpation caused severe pain. Movement at the knee and ankle joints remained intact but was limited by pain during weight-bearing. The distal nerves and blood supply were found to be normal. Radiological investigations revealed signs consistent with Chronic Osteomyelitis, including lucency around the implant, irregular bone surfaces, and sequestrum formation, suggesting infected bone surrounding the implant. These findings, combined with the clinical presentation, confirmed the presence of an infected orthopedic implant with septic bone following the earlier fixation of the tibial fracture. Based on this assessment, the medical team decided that surgical exploration, removal of the implant, and thorough debridement of the infected bone would be necessary to control the infection and promote healing.

Penninah came to the hospital with complains of;persistent pain, swelling, and discomfort over the left leg at the site of previous orthopedic surgery. She had sustained an open fracture of the left tibia several months earlier and underwent surgical debridement and external fixation with metallic implants. The initial surgery had been performed by visiting orthopedic surgeons at a public health facility. Although the immediate postoperative period had been reported as stable, she subsequently developed intermittent pain and delayed recovery. She reports that weeks prior to presentation, she experienced worsening localized pain over the mid-shaft of the left leg, particularly during ambulation and weight-bearing. She also reported swelling at the surgical site and occasional low-grade fevers. There was associated tenderness and increased sensitivity over the area of the implant. She denied any new trauma. Radiographic evaluation demonstrated features suggestive of chronic osteomyelitis, including peri-implant lucency, areas of bone irregularity, and sequestrum formation consistent with septic bone around the implant. These findings, together with the clinical picture, were in keeping with a symptomatic infected implant with underlying septic bone following prior fixation of an open tibial fracture. A decision was made to proceed with surgical exploration, implant removal, and debridement. Intraoperatively, infected and necrotic bone (septic bone) was identified around the implant. Thorough debridement was performed, sequestra were removed, and the metallic hardware was successfully extracted. Samples were taken for microbiological analysis. The wound was irrigated extensively and closed appropriately, and she was commenced on targeted intravenous antibiotics based on culture results. Penninah responded well to treatment and after awhile she stabilized and discharged home in a good state.

The medical team determined that the infection is most likely related to bacterial contamination around the implanted hardware, which has resulted in septic bone formation and delayed healing of the fracture. Due to the severity of the infection and the risk of further bone destruction, the recommended management includes urgent surgical exploration, removal of the infected implant, and thorough debridement of the infected bone and surrounding tissues, followed by targeted antibiotic therapy and close follow-up. With timely surgical management, appropriate antibiotics, and proper follow-up care, Penninah has a good chance of controlling the infection and achieving bone healing. Removal of the infected implant and debridement of the septic bone are expected to eliminate the source of infection and promote recovery. However, because chronic osteomyelitis can be difficult to treat and may recur, Penninah will require long-term monitoring, wound care, and possible rehabilitation to restore full function of the affected limb.