Acute haematogenous infection of a closed vertebral fracture.
Acute haematogenous infection of a closed fractures is rare. A 68-year-old diabetic male sustained a burst fracture of a lumbar vertebra (L2) after a fall onto his back. After 5 days of conservative management, he developed a chest infection and amoxicillin was commenced empirically. However, after 6 days his previously moderate focal L2 back pain had become more severe. Pyrexia and systemic inflammatory markers continued to rise despite administration of antibiotics. Blood cultures and a CT-guided biopsy of L2 both revealed Staphylococcus aureus which was sensitive to flucloxacillin. The patient's symptoms and signs gradually normalised following administration of flucloxacillin for 6 weeks, and the use of a cast brace. We conclude that haematogenous infection can be successfully managed non-operatively.
Marshman
Laurence A G
LA
Department of Neurosurgery, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia. l.a.g.marshman@btinternet.com
Allison
Dale
D
Molloy
Cynthia J
CJ
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005436:Floxacillin / Q000627:therapeutic use; D005596:Fractures, Closed / Q000150:complications*; D006801:Humans; D008159:Lumbar Vertebrae / Q000473:pathology; D008173:Lung Diseases, Obstructive / Q000150:complications; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D013116:Spinal Cord / Q000473:pathology; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000209:etiology*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents; D005436:Floxacillin