Ballhause Tobias Malte, Linke Philip, Hättich Annika, Klatte Till Orla, Frosch Karl-Heinz, Mader Konrad
Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 22529, Hamburg, Deutschland.
Unfallchirurgie, Orthopädie und Sporttraumatologie, BG Klinikum Hamburg, Hamburg, Deutschland.
Unfallchirurgie (Heidelb). 2024 Feb;127(2):146-150. doi: 10.1007/s00113-023-01334-9. Epub 2023 Jun 4.
The vaso-occlusive crises of sickle cell disease are accompanied by bone necrosis, which favors endogenous bacterial colonization and thus osteomyelitis. This poses a major challenge for eradication and fracture management.A 22-year-old patient with sickle cell disease sustained a multifragmentary, humeral shaft fracture. During surgical management, pus drained from the fracture site and further diagnostic work-up revealed osteomyelitis with evidence of Klebsiella aerogenes. Septicemia due to Klebsiella aerogenes had been treated 5 months prior to the accident, which occured because of a vaso-occlusive crisis. This is associated with clustered bone necrosis and endogenous germ colonization. Eradication of the germs and fracture care become a challenge. Repeated surgical procedures with segmental transfer can be a successful treatment option.
镰状细胞病的血管闭塞性危象伴有骨坏死,这有利于内源性细菌定植,进而导致骨髓炎。这给根除感染和骨折处理带来了重大挑战。一名22岁的镰状细胞病患者发生了肱骨干多段骨折。在手术治疗过程中,有脓液从骨折部位流出,进一步的诊断检查显示为骨髓炎,有产气克雷伯菌感染的证据。产气克雷伯菌引起的败血症在此次事故发生前5个月已得到治疗,此次事故是由血管闭塞性危象所致。这与聚集性骨坏死和内源性细菌定植有关。根除细菌和处理骨折成为一项挑战。采用节段性转移的反复外科手术可能是一种成功的治疗选择。