March 2019 digital v1

tuberculous granuloma. Liver function test
and renal function test was normal. He was
registered in government DOTS regime.
By 2 months, the pain and swelling
disappeared. By 6 months, ESR become
25. Completed chemotherapy by 9 months.
Rejoined in his company at Ernakulam after 7
months post op.
2yrs follow up
Patient has no complaints. On examination
terminal 10 degrees of flexion limited.
Otherwise healthy.
Differential diagnosis
1. Tuberculosis. 2. Pigmented villo-nodular
synovitis 3. Rheumatoid arthritis 4. Seronegative
arthropathy.
Tuberculosis of the knee causes triple
dislocation due to hamstring spasm and
contracture. These are flexion, posterior
dislocation, lateral rotation and adduction of
tibia. In advance cases in adults, arthrodesis
is done by using Charnley’s compression
arthrodesis. Other causes of triple deformity
are polio and rheumatoid arthritis. DOTS
treatment was for 6 months with 2 months
of four-drug regime and 4 months two-drug
regime. At my request, the medical officer
in charge of DOTs programme extended
treatment up to 9 months
X-ray AP and lateral view of right knee showing
peri articular osteoporosis
The author is additional
professor in Orthopedics,
Govt. Medical College,
Kollam, India.
TUBERCULOSIS OF CALCANEUM
Biopsy result of curetted specimen from calcaneus
Radiological and clinical photograph of a healed lesion tuberculosis of calcaneum
at 6 months
Tuberculosis affecting this bone
is a rare occurrence even though
infections are not uncommon
in calcaneum, especially in
compound injuries. Co-morbid
conditions like diabetes, arterial
diseases, smoking, alcoholism
etc. are other contributing
factors.
A 35-year-old gentleman
presented with a non-healing
ulcer at the lateral aspect of
foot. Two years back, he had
a swelling at the same region;
for which he underwent an
incision and drainage (I &D) in
a local hospital. At that time the
ulcer was healed in 2 weeks.
The 2nd recurrence occurred
after 8 months, but at that time
there was no ulcer, only pain,
which was cured by NSAIDs
and footwear modification
(micronized rubber shoes).
Now he presented with a nonhealing
ulcer at the lateral aspect
of foot at the same region of
I&D. It started 1 month back
with a swelling at the lateral
aspect of the foot. An I&D was
done at a local hospital for the
same. Culture and sensitivity
of pus yielded heavy growth of
coagulase positive staphylococci
sensitive to cloxacillin and
gentamicin. X-ray showed a
lytic lesion at the antero-lateral
portion of the calcaneum.
With the help of C-Arm,
we identified the lytic lesion,
thorough debridement was
done, and the specimen was
sent for histopathology. The lytic
space was filled with vancomycin
impregnated purified Ca SO4
(Stimulan). Suture removal was
done at 10 days post operatively,
then a below-knee plaster cast
was given.
After 6 weeks it was
converted to a walking cast for
six more weeks and then he was
allowed full weight bearing.
The case was managed with
the DOTS regime protocol. Follow
up X-ray and clinical picture at 3
months shows well healed scar
and consolidating lesion.
54 / FUTURE MEDICINE / March 2019