MANAGEMENT OF CHRONIC POST-TRAUMATIC TIBIAL OSTEOMYELITIS WITH INTRAMEDULLARY ABSCESS USING TILVAK KSHARA KARMA AND AYURVEDIC THERAPEUTICS: A CASE REPORT

Background: Chronic osteomyelitis is a persistent infection of bone and bone marrow characterized by progressive inflammatory destruction of bone tissue, sequestrum formation, sinus tract development, and recurrent purulent discharge. It commonly occurs following open fractures, orthopedic implant procedures, or inadequately treated acute osteomyelitis. The condition remains a significant therapeutic challenge because of poor local vascularity, the presence of necrotic bone, and a high risk of recurrence. Conventional management generally involves prolonged antibiotic therapy combined with surgical debridement and, in advanced cases, reconstructive procedures. Despite advances in treatment, chronic osteomyelitis continues to be associated with substantial morbidity, prolonged treatment duration, and reduced quality of life.. The present case report describes favorable short-term outcomes in chronic post-traumatic tibial osteomyelitis with intramedullary abscess treated using Tilvak Kshara Karma and Ayurvedic therapeutics. Case Presentation: A 34-year-old male presented with persistent pus discharge from the right leg for three years following intramedullary tibial nailing in 2017. Despite implant removal and two months of conventional antibiotic therapy, symptoms persisted. MRI confirmed chronic osteomyelitis with intramedullary abscess, sequestrum formation, cortical erosion, cloaca formation, and adjacent soft tissue collection. Multi-stage orthopedic debridement with reconstructive surgery was advised but declined by the patient. Intervention: Drainage of the sinus tract was performed using trocar and cannula followed by local Tilvak Kshara Karma. Internal Ayurvedic medications including Manjistha Churna, Chopchini, Rasamanikya, Shuddha Gandhaka, Giloy Satva, Praval Pishti, Panchatikta Ghrita Guggulu, and Khadirarishta were administered. Panchavalkala Kwatha Prakshalana was used for local wound cleansing. Outcome: After three weeks of treatment, complete cessation of pus discharge was observed with closure of the sinus opening. Total leukocyte count decreased from 9800 to 6350 cells/mm³ (↓35.2%), erythrocyte sedimentation rate from 25 to 13 mm/hr (↓48.0%), and C-reactive protein from 5 to 1.83 mg/L (↓63.4%). No adverse events were observed. Conclusion: This case demonstrates favorable short-term clinical and laboratory improvement in chronic post-traumatic tibial osteomyelitis managed with Tilvak Kshara Karma and Ayurvedic internal medications. Larger controlled studies with longer follow-up are required to validate these findings.