Utility of leukocyte scanning in osteomyelitis complicating a complex fracture

A 27-year-old man was surgically treated with internal fixation and fasciotomy for a complex fracture of the right tibia and fibula. This was complicated by klebsiella species infection that was treated with extensive surgical debridement of bone, insertion of an exchange tibial nail, and bone grafting. A sinus developed over the anterior tibia, draining purulent material from which klebsiella species were again isolated. Further extensive debridement was undertaken and antibiotic therapy continued. A bone scintigram showed soft tissue hyperemia and changes thought to be compatible with recent surgery. Leukocyte scintigraphy, however, identified an infective collection in the anterior soft tissues of the tibia, contiguous with the large bony defect. Further debridement was undertaken using a free muscle flap to the anterior tibial defect.