Author Question: Bone Infection after Orthopedic Surgery

Sarah Asks:

My character was assaulted and, among other injuries, her right forearm was fractured severely. It was surgically repaired using pins.

My question is: Is it possible for her to develop osteomyelitis after a blunt-force trauma (that does not result in a fracture) two years after the original injury? If not, is there another scenario that could cause osteomyelitis after the fact like that? And what would be the immediate treatment plan following the second injury and osteomyelitis? Also, if left untreated for a period of time, could osteomyelitis become life-threatening?

Jordyn Says:

The first part of your question does not seem plausible to me. First, you imply that there isn’t a fracture associated with the second injury to this arm and the length of time doesn’t quite work. The arm should be fully healed two years post surgery to repair the fracture.

If this character were to develop osteomyelitis near the site where she received a blow by a blunt object, but that arm had been previously fractured two years prior, I don’t see the medical staff thinking these two things are related. They are just too far apart.

I don’t know of another scenario that could cause this to happen two years out– that the blunt force blow (that doesn’t break the skin or cause fracture) somehow ignites an osteomyelitis at a previous surgical site. If it did, I think it would be considered happenstance.

Ostemyelitis generally happens when bacteria gets to the bone through an open wound (open fractures are a great way to write this complication) or the infection to the bone is seeded from another area in or on the body (a septic joint for instance). The infection will generally develop within two weeks.  Even in the article linked in this paragraph, chronic osteomyelitis usually develops within two months. Nothing even close to two years.

The course of treatment for osteomyelitis would depend on what bacteria (or fungus) is causing the infection. Surgery could also be indicated.

Yes, any infection can become life threatening particularly if the bacteria or fungus gets into the bloodstream.

Hope this helps and good luck with this story!

Forensic Medical Question: Forensic MRI for Child Abuse

Susan Asks:

mri-782459_1920Is there such a thing as a forensic MRI? Not to be done on a dead person, but in a child abuse case? Can one tell if a child has been beaten and see healed bruises, etc?

Jordyn Says:

Thanks for your questions.

The only indication I can think of using MRI to discern abuse would be for head trauma. MRI is the most sensitive study when it comes to differentiating old and new bleeds (as in possibly discerning two episodes of shaking), but still an exact time of the bleed could probably not be given. We just would know there were two separate instances of injury that caused bleeding.

Also, it wouldn’t be called a forensic MRI on a live child. We would just call it by the study we’re doing. In this case, a brain MRI, but the reason for doing the study would be concern for child abuse and/or intracranial (inside the brain) bleeding.

You can’t really tell healed bruises because they’re healed after all. The skin would have normal appearance. We could at least take a history of where the bruises were because we know normal versus abnormal bruising patterns in children, but pictures are always more impressive so seeing current injuries will always be better if trying to build a child abuse case.

Perhaps you’re thinking about healed fractures which you could possibly see some evidence of healed fractured on x-rays depending on how significant the fracture was. However, not all healed fractures are visible on x-ray. Healing fractures can be seen on x-ray.