I am an RN Case Manager working with an orthopedic surgeon in a large, multi-surgeon practice who has asked me to find a forum where he might discuss a problem case that he has been unable to obtain helpful in-practice feedback. In summary - 40ish y/o female presents with septic left knee post palm frond stick. C&S obtained, appropriate antibiotics by Infectious Disease Doc, knee abscess has reocurred 7x, last two were sterile abscesses. Partial synovectomy performed and 6 arthroscopic surgeries to clean out knee. Has had lengthy oral and IV antibiotic therapy. No palm frond tip found. Toxicology denies specific palm is toxic in any way. Knee cartiledge still in good shape. Immune system wnl. NOTE** Similar occurance several years ago after a fall and severely abraded knee finally resulted in a fused right knee.Any suggestions I might pass on to my orthopedic surgeon? The practice is stumped!! Thank you.

-- Amber Reid,RN,CDMS,CCM,CLCP (amberreidrn@att.net), January 08, 2003

Answers

It is inappropriate to seek specific medical advice over the internet. Specific medical case treatment requires a comprehensive physician evaluation that requires a complete history, physical and often x-rays, images and laboratory tests. Therefore, specific requests for medical advice will not be answered and will be removed. For example: "I broke my leg and my doctor operated on it 3 months ago and it is not yet healed. What can I do?" will not be answered whereas "How long does it take a broken bone to heal" will be answered as time is available.

-- David S. Hungerford, M.D. (dhunger@jhmi.edu), February 10, 2003.