Heterotopic Ossification- Induced Osteomyelitis 3 Years after a Closed Both-Bone Forearm Fracture in a Pediatric Patient: A Case Study

Osteomyelitis is an infection, predominately bacterial in origin, of the bone which incites an acute inflammatory response with subsequent bacterial and inflammatory dissemination to the cortex and periosteum. Microorganism seeding typically occurs via hematogenous spread form existing bacteremia, direct inoculation secondary to penetrating trauma, or contiguous spread from localized infection. Treatment of osteomyelitis typically requires a multidisciplinary approach, including long term oral and/or intravenous antibiotic therapy and surgical intervention. Osteomyelitis as a secondary complication of closed fractures is a rare occurrence with less than 50 document cases reported in literature to the extent of the author’s knowledge. We report an atypical case of acute osteomyelitis originating from a localized bony
spicule in a pediatric patient, more than 3 years after a surgically treated closed distal forearm both-bone (radius and ulna) fracture. The patient in this report  exhibited an atraumatic nine-month course of recurrent abscess formation and localized inflammation, despite surgical debridement and multiple rounds of antibiotic therapy. A bony spicule noted on x-ray, which the authors believe formed from early consolidation of heterotopic ossification fragments, was surgically excised, after which the patient ceased to develop recurrent abscesses. Histological analysis of the spicule revealed findings consistent with a definitive diagnosis of S. aureus (MSSA) acute osteomyelitis. In conclusion, to the extent of the author’s knowledge, this is the first reported case of acute osteomyelitis complicating a closed fracture
and localized to a bony fragment, which formed from heterotopic ossification, a known complication of fractures.