| 제목 |
Hemorrhagic Bursitis as a Complication of Transtibial Amputation: A case |
| 소속 |
Seoul Medical Center, Department of Physical Medicine & Rehabilitation1, Seoul Medical Center, Department of Orthopedic Surgery2 |
| 저자 |
Kyungyeul Choi1*, JongKyu KIM1†, Ki Chun Kim2, Ga Yang Shim1, Seung Hee Han1 |
Introduction
Stump pain is the most common complaint after lower limb amputation. Commonly it is caused by skin abrasion, neuroma, loosened socket, and mechanical failure. Sometimes infection such as cellulitis may also cause stump pain. We experienced hemorrhagic bursitis associated bony stump spur as a rare complication after transtibial amputation and report it.
Case
A 54-year-old man with both transtibial amputated state complained pain, tenderness, swelling with reddish skin color change on his left stump. He got right transtibial amputation 4 years ago due to diabetic foot ulcer with osteomyelitis. And left transtibial amputation was done with the same reason 2 years ago. For left stump, he suffered for neuropathic pain, and have surgical neuroma excision twice. His last surgery was 6 months ago.
MR image showed soft tissue swelling and septated fluid collection at the stump with rim enhancement, with spicular margin, bone marrow edema at the amputated end of the tibia.(Figure 1 & 2) Official radiologic reading suggested bursitis below the bony projection of the stump, less likely infection.
Ultrasound-guided aspiration of the bursa was tried and 50cc of red colored fluid was aspirated. Then his pain was relieved. Microscopic exam of the fluid suggested hemorrhagic bursitis.
He was referred to orthopedics for surgical excision of the bursa. At the surgical field, the spinous bony spur at the end of the tibia was found. (Figure 3) Total bursectomy with bony stump grinding was done.
At POD#47, he discharged to home using both prostheses. Now he can walk independently for 100m outdoor with prostheses.
Conclusion
We experienced hemorrhagic bursitis associated bony stump spur after transtibial amputation. It mimics infection such as bursitis and cellulitis. Further study about bony stump spur formation after amputation may be needed. |
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Figure 1. Serial X-ray of the stump - (A)2yrs ago, (B)6months ago, (C)before bursectomy, (D)after bursectomy
Figure 2. MR image of the stump - (A)Coronal, (B)Sagittal, (C)Axial T1WI images with contrast enhancement
Figure 3. Surgical finding - Black arrow indicates spinous bony spur of the tibial stump
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