case_images: PMC11195031_01
case_images: X-ray AP and Lateral views showing lytic lesion (Arrow) with erosion and periosteal reaction
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case_images: F1
case_images: Basic radiological evaluation of knee, on x-ray was suggested erosion of the anterior cortex of patellar margin [Figure1].
case_images: MRI images (A) Axial Section; (B) Sagittal Section
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case_images: F2
case_images: MRI was suggestive of focal osteomyelitis of the patella with anterior surface erosion and associated collection extending anteroinferior subcutaneous planes over the patellar tendon [Figure 2].
case_images: Chest X-ray PA view suggestive of rib fracture and left-side pleural effusion obliterating costophrenic angle
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case_images: F3
case_images: X-ray chest evaluation showed an old 5th rib fracture with pleural effusion obscuring the left costophrenic angle [Figure 3].
case_images: Intra-op Images showing (A) caseous yellow bone necrosis and (B) a biopsy sample for histo-pathology
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case_images: F4
case_images: Intraoperatively, author found that the osteomyelitis showed friable necrotic tissue with caseous necrosis of bone, as shown on the clinical picture [Figure 4]. All of the pathological tissue, along with the prepatellar bursa, was resected and curetted and sent for histopathology, acid-fast bacillus culture, and sensitivity, along with gram culture [Figure 4]. 
case_images: Post of Knee x-ray AP and Lateral views showing bioabsorbable calcium beads Impregnated with antibiotics
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case_images: F5
case_images: As there was a primary suspicion of post-traumatic bacterial osteomyelitis, we placed biodegradable calcium pellets mixed with the empirical antibiotic (colistin) so that sustained release of the antibiotic could control osteomyelitis [Figure 5].
case_images: . Histopathological microscopic slide showing early forming granulomas (yellow Arrow)
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case_images: F6
case_images: Histopathological examination of biopsied soft tissue and bony material showed necrotic areas surrounded by histiocytes, variable lymph plasma cells, neutrophils and occasional multinucleated giant cells without signs of malignancy [Figure 6].
case_images: Follow-up x-ray knee AP and Lateral views after 6 year shows complete bone healing
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case_images: F7
case_images: After 6 years of follow-up, X-rays show complete healing, and the patient remains asymptomatic and without any signs of local recurrence [Figure 7, 8].
case_images: Clinical picture of complete wound healing (scar) and no discharging sinus
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case_images: F8
case_images: After 6 years of follow-up, X-rays show complete healing, and the patient remains asymptomatic and without any signs of local recurrence [Figure 7, 8].