Osteomyelitis of the great trochanter after removal of a femoral nail: a case report

BACKGROUND: Osteomyelitis following orthopedic hardware removal is a rare but serious complication, particularly in pediatric patients. This case report describes a unique instance of osteomyelitis of the great trochanter following the removal of a femoral nail in a 14-year-old girl, highlighting diagnostic challenges and management strategies.

CASE PRESENTATION: A 14-year-old Mediterranean white girl presented with persistent pain and swelling at the site of a previously removed femoral nail, used to treat a prior femoral shaft fracture. Symptoms developed 2 weeks post-removal, accompanied by erythema and increased warmth over the great trochanter. Laboratory findings showed elevated inflammatory markers. Imaging studies, including magnetic resonance imaging, confirmed osteomyelitis of the great trochanter. The patient underwent surgical debridement, followed by targeted intravenous antibiotic therapy based on culture sensitivities. The patient responded well to surgical debridement and a 3-week course of intravenous antibiotics, with subsequent transition to oral antibiotics. Follow-up at 1 year showed resolution of symptoms, normalization of inflammatory markers, and no signs of infection recurrence on imaging. The patient was free of pain, demonstrated complete range of motion, and the wound showed no signs of infection, as confirmed by clinical examination and accompanying photographs.

CONCLUSION: This case underscores the importance of prompt diagnosis and comprehensive management of osteomyelitis following hardware removal in pediatric patients. Early intervention with appropriate surgical and antibiotic treatment can lead to excellent outcomes in managing this rare complication.