Loose bodies in right elbow joint: Post traumatic? or post infective?
We report a 30 year old man referred to our institution for road traffic accident and presented with pain, swelling, deformity, Gustilo grade 3A open wound in right elbow with compound fracture. His personal and family history was not significant. The patient has no history of fever, anorexia, weight loss and night sweats.\nPlain radiograph revealed a compound intercondylar fracture right humerus with communited right olecranon. Open reduction and internal fixation after proper debridement with plates was performed. On the 5th post-surgical day, patient had sero sangious discharge from the operative wound, for which debridement was done. After repeated debridement's and wound closure patient was sent home. The patient came with chronic discharging sinus from the wound over posterolateral aspect of elbow, for which repeated pus culture and serological tests were performed, which was found to be negative. Prophylactic broad spectrum antibiotic therapy was started for 6 weeks but the patient still had persistent discharging sinus. Six months later the patient returned to outpatient clinic with recurrence of discharging sinus, pain associated with increased range of motion, hyper and abnormal mobility. On earlier plain radiography, there were no notable findings, however after 6 months implant failure was revealed [], with joint space narrowing and peri articular osteopenia. Laboratory investigations included hematocrit value of 36.6%, total leukocyte count was normal, ESR was 57mm/hour, and C-reactive protein was 6 mg/dl. Rheumatoid factor and anti-nuclear anti-body was negative. Pus culture was negative. Patient underwent thorough generalized clinical and radiological examination. Various specimens like sputum and urine were send for ZN staining but there was lack of any primary foci elsewhere in his body.\nRepeat debridement and implant removal was performed. Some suspicious rice seed like bodies were removed and sent for histopathological examination. Histological examination [] showed circumscribed homogenous fibrinous bodies with focal area of hyalinization and scanty focal acute inflammatory infiltrate. Few bodies had embedded tiny osteolytic fragments. Acid Fast Bacilli staining (Ziehl-Neelsen Staining) was done and found positive.\nPatient was started with anti tubercular four-agent drug treatment using isoniazid, rifampin, pyrazinamide, and ethambutol. On regular follow up, the sinus healed fully and patient had good range of motion without pain and fracture healed.