Ahmed M Abdelhai¹, Mohammed Hassan Babiker², Hassan Elbahri³, Dafaalla Salih Altyar⁴ and Hozifa Mohammed Ali Abd-Elmaged⁵*

¹Assistant Professor, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
²MD Orthopedics and Trauma SMSB, Khartoum, Sudan
³Associate Professor, Faculty of Medicine, International University of Africa, Sudan
⁴Medical Student at Al-Zaiem Al-Azhari University, Khartoum, Sudan
⁵Assistant Professor, Faculty of Medicine, University of Khartoum , Kartoum, Sudan

*Corresponding Author: Hozifa Mohammed Ali Abd-Elmaged, Assistant Professor, Faculty of Medicine, University of Khartoum , Kartoum, Sudan.

Received: August 30, 2022; Published: October 11, 2022

Abstract

Introduction:The misdiagnosis of skeletal manifestation of sickle cell anaemia, Mostly bone Infraction as an infection, depending on the same clinical presentation and the x-ray findings.

Methodology: This is a descriptive prospective multi-centric hospital-based study. conducted in Khartoum, the Capital of Sudan in several hospitals, the study included 50 patients with SCA with skeletal manifestation. Which presented to hospitals during the study period.

Results: Sensitivity, specificity, positive predictive value and negative predictive value of final diagnosis (as osteomyelitis) were 46.7%, 90.9%, 87.5% and 94.7% respectively. The sensitivity, specificity, positive predictive value and negative predictive value of final diagnosis (as bone infarction) were 72%, 53.3%, 94% and 88.9% respectively, which significantly indicates low reliability of using X-Ray in the diagnosis of skeletal manifestations among SCD patients (P < 0.05).
Comparing between initial and final diagnoses realized the tendency to change from infection to infarction after initiation of treatment, which is mostly due to a lack of proper workup.
Radio-leucency was the most common X-Ray finding among the studied patients, followed by osteoscelerosis, joint destruction osteopenia and bone collapse. Finally patients diagnosed with bone infarction, underwent bone debridement in their course of treatment before the definitive diagnosis as infarction and 82% of them were given a long course of antibiotics

Conclusion: We Note the necessity of clinical assessment and x-ray imaging in SCD workup, further imaging and investigation have to be done before diagnosing the patient as osteomyelitis and proceeding with aggressive management. In addition to radioisotope imaging which provides useful information about acute osteomyelitis.

Keywords: Sickle Cell Anaemia (SCA); Red Blood Cell (RBC); Sickling

References

1. Sabahelzain MM and Hamamy H. “The ethnic distribution of sickle cell disease in Sudan”. The Pan African Medical Journal 18 (2014): 13.
2. Ejindu VC., et al. “Musculoskeletal Manifestations of Sickle Cell Disease”. Radio Graphics 27 (2007): 1005-1021.
3. Kosaraju V., et al. “Imaging of musculoskeletal manifestations in sickle cell disease patients”. British Journal of Radiology 90 (2017): 20160130.
4. Wilson SC and Skinner HB. “Orthopedic Infections, Chapter 8”. in Skinner, H. B et al. Current Diagnosis and Treatment in Orthopedics, Fourth Edition; The McGraw-Hill Companies, Inc. (2006).
5. Ware HE., et al. “Sickle cell disease and silent avascular necrosis of the hip”. The Journal of Bone and Joint Surgery. British Volume 73 (1991): 947-949.
6. Babhulkar SS., et al. “The hand-foot syndrome in sickle-cell haemoglobinopathy”. The Journal of Bone and Joint Surgery. British Volume 77 (1995): 310-312.
7. Stevens MC., et al. “Observations on the natural history of dactylitis in homozygous sickle cell disease”. Clinical Pediatrics (Phila) 20 (1981): 311-317.
8. Styles LA and Vichinsky EP. “Core decompression in avascular necrosis of the hip in sickle-cell disease”. American Journal of Hematology 52 (1996): 103-107.
9. Skaggs DL., et al. “Differentiation between bone infarction and acute osteomyelitis in children with a sickle-cell disease with the use of sequential radionuclide bone marrow and bone scans”. The Journal of Bone and Joint Surgery. American Volume 83-A (2001): 1810-1813.
10. Keeley K and Buchanan GR. “Acute infarction of long bones in children with sickle cell anemia”. Journal of Pediatrics 101 (1982): 170-175.
11. Doka KA. “Musculoskeletal complications of SCD patients in Khartoum sickle cell clinic Khartoum-Sudan” (2008).
12. Sid Ahmed K M. “Differentiating osteomyelitis from vaso-occlusive crises in SCA” (2012).

Citation

Citation: Hozifa Mohammed Ali Abd-Elmaged., et al. “Skeletal Manifestations of Sickle Cell Disease, Role of Plain Radiograph in Predicting the Diagnosis and Management". Acta Scientific Orthopaedics 5.11 (2022): 65-70.

Copyright

Copyright: © 2022 Hozifa Mohammed Ali Abd-Elmaged., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.