Patient Information:
Name: Ahmed Khan
Age: 8 years
Gender: Male
Ethnicity: South Asian
Religion: Muslim
Socioeconomic Status: Middle-class
Presenting Complaints:
Ahmed Khan was brought to the hospital with complaints of severe pain and swelling in his left lower leg. He was unable to bear weight on the affected leg and had developed a fever in the past few days. The parents noticed that Ahmed had become increasingly irritable and had difficulty sleeping due to the pain.
History of Presenting Complaints:
The parents reported that Ahmed had initially complained of a minor injury to his left leg while playing soccer about two weeks ago. They noticed a small abrasion on his shin but did not consider it serious. However, over the next few days, Ahmed started experiencing increasing pain and swelling in the area. He developed a fever, and the pain became so severe that he couldn’t walk or even put pressure on the leg.
Chief Complaints:
Severe pain and swelling in the left lower leg.
Inability to bear weight on the affected leg.
Fever and irritability.
Past Medical and Surgical History:
Ahmed had a history of good health with no significant medical or surgical interventions. He had received all his vaccinations and had not been hospitalized before this episode.
Family History:
There was no family history of bone-related disorders or chronic illnesses.
Present and Pre-morbid Functional Status:
Prior to the injury, Ahmed had been an active and healthy child, engaging in various outdoor activities, including soccer.
General Health Status:
Ahmed appeared pale and fatigued. He was visibly in distress due to the pain.
Vitals:
Temperature: 101.2°F (38.4°C)
Heart Rate: 110 bpm
Blood Pressure: 110/70 mmHg
Respiratory Rate: 20 bpm
Aggravating Factors:
Walking or bearing weight on the affected leg.
Movement of the left leg.
Easing Factors:
Resting and keeping the leg elevated.
Minimal movement of the affected leg.
Examination:
Physical examination revealed a visibly swollen and erythematous left lower leg. There was tenderness upon palpation over the shin area. The leg was warm to touch. Ahmed exhibited signs of pain and discomfort during the examination.
Sleep and 24-hour Pattern:
Ahmed’s sleep was disturbed due to the pain. He reported waking up multiple times during the night.
Duration of Current Symptoms:
Symptoms had been present for about two weeks, with a gradual progression in severity.
Mechanism of Injury/Current Symptoms:
Ahmed had sustained a minor abrasion on his left shin while playing soccer. It is suspected that this injury provided an entry point for bacteria, leading to the development of osteomyelitis.
Progression Since the Current Episode:
The pain and swelling had progressively worsened since the initial injury. Ahmed’s inability to bear weight on the leg had also worsened.
Significant Prior History:
No significant prior history was reported.
Previous Treatment:
The parents had initially cleaned the abrasion and applied an over-the-counter antiseptic ointment. However, they did not seek further medical attention until Ahmed’s condition worsened.
Diagnostic Test/Imaging:
X-rays of the left lower leg revealed cortical thickening and periosteal elevation, suggestive of osteomyelitis. Blood tests showed elevated white blood cell count and inflammatory markers.
Differential Diagnosis:
Osteomyelitis
Cellulitis
Fracture
Postural Observation:
Ahmed favored his right leg while standing to avoid putting weight on the left leg.
Precaution and Contraindications:
Avoid any weight-bearing activities on the affected leg.
Functional Movement Analysis (Sign):
Ahmed displayed significant pain and discomfort during attempts to move the left leg.
Quick Screening Tests/Clearing of Additional Joint Structures:
No additional joint structures were affected in this case.
Range of Motion (ROM):
Limited range of motion due to pain and swelling.
Special Tests:
None mentioned in the case study.
Assessment:
Ahmed Khan presents with acute osteomyelitis of the left lower leg, likely stemming from an initial minor abrasion. The infection has caused significant pain, swelling, and fever.
Problem List/Complaints:
Severe pain and swelling in the left lower leg.
Inability to bear weight on the affected leg.
Fever and irritability.
Treatment:
Hospitalization and intravenous antibiotics.
Pain management.
Rest and elevation of the affected leg.
Close monitoring of the infection’s progress.
Prognosis:
With timely and appropriate treatment, Ahmed’s prognosis is favorable. However, early intervention is crucial to prevent further complications.
Goals:
Control and eliminate the infection.
Alleviate pain and discomfort.
Restore full functionality of the affected leg.
Interventions:
Intravenous antibiotics administration.
Pain management with appropriate analgesics.
Resting and elevating the leg.
Regular monitoring of vital signs and laboratory results.
Patient Education:
Importance of completing the full course of antibiotics.
Restricted weight-bearing on the affected leg.
Signs of infection recurrence.
Patient/Family Education:
Administering antibiotics on schedule.
Monitoring for signs of improvement or worsening.
Following medical instructions for wound care and hygiene.
Discharge Plan :
Upon improvement, Ahmed will be discharged with oral antibiotics for continued treatment. Regular follow-up appointments will be scheduled to monitor his progress and ensure the infection has been fully treated. He will gradually resume weight-bearing activities based on medical recommendations.