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March 2012 - Case History - Nalwadda Juliet
Juliet was born on 15th. January 2002. She was admitted to ACHERU on 26th. November 2010.
Juliet before surgery Juliet after surgery
Juliet (May 2011), before & after surgery
Historical background.
Juliet is the fourth child in a family of five children and the last born of her mother so far. Unfortunately the parents separated some years back, Tracy (the mother), went back to stay with her mother who is also single, so Juliet stays with her mother and grandmother.
Last year she was studying in primary 2 and this year she should be in primary 3 but due to the sickness she has not started yet. Last year (2010) when Juliet was at school, she got a misunderstanding with a boy over her age who gave her a direct hard kick on the left lower limb around the knee joint. She never reported this to anybody until after three days when the pain increased and the limb had started swelling. She was taken to a nearby Health Centre where she was given an injection. This made the situation worse. They then tried some local healers who mismanaged the fracture and the marrow was badly affected in the process. The pain became very severe and the thigh swelled up. When the father was informed of the situation, it happened that he had heard of ACHERU so he directed them to here for treatment. By the time we received the girl it had started discharging pus seriously.
It was found that the posterior aspects of the left femur had an immobility to bear the weight. It had also developed Osteomyelitis with pathological femur . She was admitted to the ward at ACHERU on 26th November 2010 and started on antibiotics and daily dressing. Later she was Xrayed on the knee at CoRSU on 2nd Dec.2010 and admitted to CoRSU on 9th Dec 2010.
Juliet was operated on 15th Dec.2010 for ‘segestrectomy’ plus external fixator. During the operation, there was a bone loss as the fracture had developed Osteomyelitis. An external fixator had to be applied to let the bones grow properly to cover that gap.
After 11 days stay at CoRSU she was discharged back to ACHERU for treatment. She is now on a daily dressing. She has a great improvement! No more discharge even the swelling disappeared.
Juliet was re-admitted at CoRSU on 18th April 2011 for a review on her chronic Osteomyellitis. She went through a sequestrectomy operation on 18th April 2011. They also did a wound exploration and screw adjustment on 20th. April 2011. Some particles of dead bone were removed. During that time a blood slide for malarial parasites was taken and it gave positive results, she was given anti-malarial treatment.
Daily wound dressing and physiotherapy done together with some antibiotics and analgesia. She was discharged on 21st.April 2011.
After discharge, we continue with daily dressing at ACHERU.
The sites of operation have now healed but some sinuses have re-appeared and the area in the first operation site has started oozing again. Dressing continues.
Update received 31/7/2011
Juliet was taken for a consultation clinic at CoRSU on 26th May where an x-ray showed a non union of the femur - a change of fixator was planned for 13/6/2011.
This time they changed to an Illizarov.
She spent 13 nights in CoRSU. She was given a compensation shoe and is now on daily dressing and antibiotics.
She is happy with great improvement.

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