A bone infection almost cost Jonah his leg

Play is the ingredient that gives infancy its flavour. We chuckled, giggled, rolled in the sand, jumped off mounds, chased our peers and climbed trees. In turn, wounds, scars and bruises were sculpted on our skins.

But did you know that a bad injury could result into something more tragic, like a bone infection?

Seven-year-old Jonathan Wasswa, a resident of Nkumba has lived through the pain of a bone infection, medically called osteomyelitis.

Jonah (L) plays with a friend

HIS STORY

Wasswa was at his best on the morning of December 26, 2012.

Standing on a low stool, he chorused, ‘mbuuke mbuuke?’ (should I jump, should I jump?) His friends responded, ‘buuka!’ (jump) and he did. The jump left him with a broken bone and swollen limb. The pain stung every part of his body making the little child wail.

His mother, Maria Specioza Nalwanga consulted a herbalist who wrapped Wasswa’s injured leg with herbs, as pain relief agents and treatment. The herbs lasted one week but did no good. His leg turned yellow and the swelling got bigger.

On February 14, he was taken to Mulago hospital for an X-Ray which revealed an internal bone fracture. His leg was put on traction, a set of mechanisms to straighten broken bones or relieve pressure on the spine and skeletal system, and the leg was encased in a cast.

Jonah and his mother after his incident of an injured leg

“Before [the cast could be removed], his leg oozed large volumes of pus, so much so that it seeped through the two mattresses on his bed, and on to the floor,” Nalwanga recalled, adding that he was taken back to Mulago.

It was discovered that he had a wound on the inner side of the left knee. By then, he had lost appetite and was immobile. On April 9, 2013, he was referred to CoRSU (Comprehensive Rehabilitation Services in Uganda) in Kisubi for surgery to rid him of the dead bone due to osteomyelitis.

ABOUT OSTEOMYELITIS

Osteomyelitis is a bone infection often caused by bacteria called staphylococcus aureus. In children, it usually affects the long bones of the arms and legs.

“Patients usually present with pain, swelling, pus discharge in the affected area and sometimes, one may be unable to use the affected limb,” explained Dr Paul Muwa, an orthopedic specialist at CoRSU. Additionally, patients might have fever and chills and feel nauseated.

Osteomyelitis is more common in children because their bones are more vulnerable as they are not fully grown. Malnourished children and those from poor socio-economic backgrounds are more prone to the condition.

If not treated quickly, it leads to the chronic stage with severe bone destruction that may necessitate amputation.

Adults are also predisposed to bone infection because of increased incidence of diabetes and poor dentition and frequent surgical procedures such as open heart surgery and dental extractions.

At CoRSU, bone infection is the orthopedic condition with the highest number of surgical procedures. Out of 3,018 procedures last year, 747 were due to osteomyelitis.

DIAGNOSIS AND TREATMENT

Records indicate that it is sometimes difficult to diagnose osteomyelitis in infants and young children because they don't always show pain or specific symptoms in the area of the infection. 

When Wasswa was admitted at CoRSU, he was examined and had a bone X-Ray.

“The X-Ray revealed that one bone overlapped the other and that the head of the femur (thigh bone) had been eaten by bacteria,” Moses Kiwanuka, CoRSU’s head of community-based rehabilitation said.

Immediately, Wasswa was put on antibiotic treatment through an intravenous drip (IV) to stop the bacteria in its tracks. In some instances, like it was in Wasswa’s, Kiwanuka said osteomyelitis can become severe and a hole may develop in the bone.

Pus and a collection of bacteria may have formed in the hole and this calls for a surgical procedure to drain the pus to allow the bone to heal completely.

Once the condition improves, a patient is discharged but continues with oral antibiotics for several weeks.

Dr Muwa, however, noted that recovery depends on the state of a patient’s condition i.e. how much of the bone is involved.

PREVENTION AND HOME CARE

A vibrant Jonah relaxes in the lawn

Kiwanuka said the easiest way to prevent osteomyelitis is to practice good hygiene.

“One needs to keep wounds clean and this can be done through traditional sterilization using cotton wool and warm salty water and cover it with sterile gauze or a clean cloth to avoid its exposure to infection,” he urged.

For those that have undergone surgical procedure, regular exercise such as walking helps in restoring the mobility of the affected body part. Kiwanuka also calls for improved nutrition, a balanced diet, to boost the body’s immunity.

 Before the infection, Wasswa mainly fed on rice, groundnut sauce and matooke. Today, his diet has widened to include eggs, small fish (mukene) and posho. The lively and warm Wasswa now spends his days helping ‘mummy’ in the garden.

The possibility of him returning to school and graduating into a medical doctor is as ripe as it was two years ago.