Lahey Hospital and Medical Center, Burlington, MA, USA.
University of Maryland Medical Center, Baltimore, MD, USA.
Am Surg. 2023 Jun;89(6):2973-2975. doi: 10.1177/00031348221101580. Epub 2022 May 10.
Rib osteomyelitis can be caused by a contiguous infection after a traumatic fracture. Post traumatic osteomyelitis can present as chronic six or more weeks after bone infection. However, this patient developed first rib osteomyelitis 17 years after trauma, following the initiation of anticoagulation therapy. 17 years ago, a 55-year-old male patient was in a motor vehicle collision. He was diagnosed with a left first rib fracture and an internal carotid dissection. He subsequently underwent a left subclavian central venous catheter placement. His rib fracture was managed nonoperatively and the carotid dissection was treated with endovascular stent placement. He now presents with symptomatic carotid stent stenosis which is treated with anti-platelet and anticoagulation therapy. He then developed a hematoma over the old rib fracture, and subsequently developed acute osteomyelitis. As seen here, a remote history of traumatic first rib fracture remains a risk factor for osteomyelitis despite the passage of time.
肋骨骨髓炎可由创伤性骨折后的邻近感染引起。创伤后骨髓炎可在骨感染后 6 周或更长时间呈现慢性表现。然而，这名患者在开始抗凝治疗 17 年后，出现第一肋骨骨髓炎。17 年前，一名 55 岁男性患者遭遇车祸。他被诊断为左第一肋骨骨折和颈内动脉夹层。随后，他接受了左锁骨下中心静脉导管置管术。他的肋骨骨折采用非手术治疗，颈动脉夹层采用血管内支架置入治疗。他现在出现症状性颈动脉支架狭窄，接受抗血小板和抗凝治疗。然后，他在陈旧性肋骨骨折处出现血肿，随后发生急性骨髓炎。如所见，尽管时间过去了，但创伤性第一肋骨骨折的既往史仍然是骨髓炎的一个危险因素。
