Delayed Presentation of First Rib Osteomyelitis Following Trauma

Area of Science:

• Orthopedics
• Infectious Diseases
• Vascular Surgery

Background:

• Osteomyelitis, a bone infection, can arise from contiguous spread after trauma.
• Post-traumatic osteomyelitis typically manifests within weeks to months following the initial injury.

Observation:

• A 55-year-old male with a 17-year-old left first rib fracture developed acute osteomyelitis.
• The patient had undergone nonoperative management for the rib fracture and endovascular stenting for carotid dissection.
• Symptomatic carotid stent stenosis prompted anti-platelet and anticoagulation therapy, leading to a hematoma at the old fracture site.

Findings:

• Acute osteomyelitis developed in the first rib 17 years after the initial traumatic fracture.
• Anticoagulation therapy initiated for carotid stent stenosis preceded the development of osteomyelitis.
• A remote history of traumatic rib fracture was identified as a risk factor for late-onset osteomyelitis.

Implications:

• Remote traumatic rib fractures may represent a long-term risk factor for developing osteomyelitis.
• Anticoagulation therapy could potentially precipitate osteomyelitis in individuals with a history of bone trauma.
• This case underscores the importance of considering remote trauma in the differential diagnosis of late-onset osteomyelitis.