Osteomyelitis and Septic Arthritis in the Developing World. Presentation.

Although this important and often serious complication should be rare when good aseptic techniques have been used it can still occur and may present a problem in making the diagnosis.

In a malarial endemic zone when an orthopaedic patient often with a limb or joint encased in plaster, develops a post operative fever an anti-malarial tablet may be administered without following the basic surgical tenet of inspecting the wound. This unfortunate situation together with a failure to appreciate the potential and real problems with post operative and post fracture swelling associated with tight plasters or bandages is even more likely to occur in patients who are lodging in Wards not staffed by Nurses or Doctors well experienced in the care of Orthopaedic Children and Adults.

The patient is likely to complain of increasing pain together with fever and malaise, and these are always danger symptoms and signs after a closed reduction or an open operation. Again the most important point in arriving at a correct diagnosis is to think of the possibility and then to examine the patient carefully, thoroughly and repeatedly. A window may need to be opened in a complete plaster cast, or dressings removed in order to allow this to be done.