Bilateral clavicle osteomyelitis: A case report

INTRODUCTION

Osteomyelitis of the clavicle is rare. Infection occurs from hematogenous spread or trauma. In adults infection is usually secondary due to an exogenous cause such as open fractures, surgery (iatrogenic) or spread from local tissue with infection.

PRESENTATION OF CASE

The case is presented here of a 50-year old female with bilateral clavicular fractures, who was operated on with open reduction and internal fixation. At the 6-month follow-up, she had complaints of bilateral osteomyelitis which was successfully treated with resection of the infected segment of the bone, and antibiotic impregnated collagen.

DISCUSSION

Predisposing factors include diabetes, intravenous drug abuse, tuberculosis or immune suppression. Management involves the removal of bone fixation, debridement of the bone and if there is a defect, coverage with a muscle flap is applied.

CONCLUSION

In cases of clavicular osteomyelitis where infection continues despite debridement and antibiotic therapy, excision of the sequestered clavicular section is a successful treatment approach and has been seen to improve quality of life without any functional loss.     

不剥离骨膜法肋骨钉内固定治疗多发肋骨骨折的随机对照研究

目的 探讨不剥离骨膜法肋骨钉内固定术治疗多发肋骨骨折的效果.方法将44例肋骨骨折患者随机分成不剥离骨膜组和剥离骨膜组,每组各22例,不剥离骨膜组应用不剥离骨膜法行肋骨钉内固定术治疗,剥离骨膜组应用传统方法（剥离骨膜）行肋骨钉内固定术治疗.比较两组手术时间、镇痛药物使用时间、术后胸腔引流液量及肋骨愈合情况.结果不剥离骨膜组及剥离骨膜组均顺利完成手术,手术时间不剥离骨膜组为（75.86±13.40）分,剥离骨膜组为（88.91±16.12）分（P〈0.01）;使用镇痛药物时间分别为（7.86±1.42）天,（9.09±1.19）天（P〈0.01）;手术后胸腔引流量分别为（619.55±94.59）ml,（678.18±101.07）ml（P〈0.05）,差异均有统计学意义.不剥离骨膜组肋骨断端对位对线良好,骨痂形成较早,骨折线消失较早.结论不剥离骨膜法肋骨钉内固定术相对于剥离骨膜法行肋骨钉内固定术治疗多发性肋骨骨折,具有手术方法简便、创伤相对小、术后疼痛轻、固定满意、恢复快等优点,值得临床推广.     

Post-traumatic osteomyelitis of the clavicle: A case report and review of literature

Osteomyelitis of the clavicle is a rare form of infection occurring from hematogenous spread or trauma. This has been reported following head and neck surgery, and subclavian catheter placement. In traumatic cases, the management involves removal of bone fixation, debridement of the bone and coverage with a muscle flap.     

Cavernous hemangioma of the rib diagnosed preoperatively by percutaneous needle biopsy

A 74-year-old man presented to our hospital with persistent low-grade back pain that had continued for 6 months. An expansile tumor containing delicate bony trabeculae was found in the posterior portion of the left fifth rib. Preoperative examination of a percutaneous needle biopsy specimen suggested a diagnosis of hemangioma; postoperative pathology examination of the resected tumor confirmed this diagnosis. We emphasize the value of preoperative needle biopsy in determining the most suitable treatment for these rib tumors.     

A case report of invasive candidiasis and fungal osteomyelitis mimicking oropharyngeal carcinoma recurrence in an immunocompetent patient following transoral robotic surgery

IntroductionTransoral robotic surgery(TORS) for the excision of oropharyngeal tumour is increasingly considered for its lower rates of postoperative complications and better functional outcomes. However, we report a case of invasive candidiasis in an immunocompetent patient with previous radiation therapy years ago who underwent TORS recently.Case presentationA 55 year old Chinese female with previous radiation therapy for nasopharyngeal carcinoma diagnosed in 1986 underwent wide excision of a newly diagnosed oropharyngeal carcinoma with TORS. From 4 to 8 weeks post-op, an enlarging exophytic lesion at the surgical excision site was noted. Initial biopsy did not show malignancy or fungal organisms. A repeat biopsy under anaesthesia was done as CT imaging showed suspicion of either infective or tumour recurrence. The patient was treated with long term antifungals as final culture results showed invasive candidiasis. The surgical site showed no further lesions 6 months post-op.DiscussionPrevious radiation therapy to the oropharyngeal area predisposes a patient to colonization of fungal organisms. Despite TORS showing lower rates of infection, patients who have had previous radiotherapy may be more susceptible to infections as the dissection involves down to the pre-vertebral fascia. Hence, it is appropriate for such patients to have microbiological and fungal cultures performed for a lesion such as this and be treated according to the results of the culture.ConclusionThis case serves as a reminder of the risk of invasive candidiasis requiring early investigation and treatment in an immunocompetent patient with prior history of both radiation therapy and recent TORS.     

Posttraumatic tuberculous osteomyelitis of the foot-A rare case report

Skeletal tuberculosis developing after trauma is a rare occurrence.We report a rare case of posttraumatic tubercular osteomyelitis of mid-tarsal bone of the right foot. Patient was treated with regular dressing and anti-tubercular drugs. Posttraumatic skeletal tuberculosis should be considered in patient with nonhealing ulcer.     

Preoperative and early postoperative three-dimensional changes of the rib cage after posterior instrumentation in adolescent idiopathic scoliosis

Rib cage deformity is an important component of scoliosis, but few authors have reported the three-dimensional (3-D) effect of surgical procedures with posterior instrumentation systems on the shape of the rib cage. The objective of this prospective clinical study was to measure the short-term 3-D changes in the shape of the rib cage at the apex of the curve after corrective surgery of adolescent idiopathic scoliosis by a posterior approach using a multi rod, hook and screw system. The 3-D shape of the spine and rib cage was modelled pre- and postoperatively using a 3-D reconstruction technique based on multi-planar radiography in a group of 29 adolescents with idiopathic scoliosis. Geometrical indices describing the scoliotic deformity of the rib cage were computed from these models and were compared pre- and postoperatively using Student's t-tests. The frontal spinal curve correction averaged 53% in the frontal plane, while no significant change was noted in the sagittal plane. Significant changes were noted in the shape of the rib cage: rib hump at the apex and at the adjacent lower level were improved (36% and 38%), and small but significant differences were detected in rib frontal orientation in the concavity of the curves at the apex and adjacent lower rib levels. Multi rod, hook and screw instrumentation systems, such as Cotrel-Dubousset instrumentation, are effective in producing significant improvements in the 3-D shape of the rib cage, but these changes are less important than those observed at the spine level.     

A case of relapsing Salmonella osteomyelitis in a thalassaemia trait patient

We report a case of chronic relapsing osteomyelitis caused by Salmonella Stanley in a β-thalassaemia trait patient who is otherwise normal. The importance of obtaining definitive bacteriological diagnosis and timely intervention to treat bone infection effectively is emphasised here.     

恶性网织细胞肉瘤误诊为急性骨髓炎1例

<正>患者,女,20岁,入院前16d右小腿上部红肿疼痛,全身发热,体温39℃左右。病后第2天在当地乡卫生院就诊,诊断为"右小腿软组织感染",给予青霉素静脉点滴治疗。患者症状不见好转,肿胀进一步加重,疼痛较轻可以忍受,体温持续在     

89例真菌性尿路感染的临床分析

目的了解真菌性尿路感染的临床特点、病原菌及药敏。方法回顾性分析真菌性尿路感染有关的临床资料。结果共398例尿路感染患者，其中剀例诊断真菌性尿路感染（占22．36％）；念珠菌85株（占95．50％）；重症监护室（ICU）患者57例（占64．04％）。结论真菌性尿路感染多发生在ICU病房，发病诱因与抗生素使用及留置尿管等有关，以念珠菌为主，耐药率低。     

Chiari畸形伴胸椎侧凸患者两侧肋骨长度差异及其与剃刀背畸形的相关性

目的:评估Chiari畸形伴胸椎侧凸患者两侧肋骨长度的差异及其与剃刀背畸形的相关性,探讨两侧肋骨生长的差异性是否为继发性改变。方法:选取Chiari畸形伴脊柱侧凸(scoliosis secondary to Chiarimalformation,SSCM)患者38例(SSCM组),年龄9~17岁(12.3±3.6岁),身高155.4±10.8cm,Cobb角26°~108°(44.9°±23.5°);顶椎位于T7~T9。另选58例青少年特发性脊柱侧凸(AIS)患者作为对照,均为右胸弯,年龄10~18岁(13.7±2.6岁),身高157.6±11.5cm,Cobb角28°~102°(43.9°±17.2°),顶椎位于T7~T9。剃刀背畸形角(ribhump,RH)均使用Scoliometer测量,采用螺旋CT三维重建的方法(volume viewer workstation)测量所有患者凹凸侧12对肋骨的长度,比较两组患者顶椎区、上下端椎及非侧凸区两侧肋骨的长度,分析顶椎区肋骨的对称性及其与Cobb角和RH的相关性。结果:SSCM组患者顶椎区(顶椎、顶椎上一椎体及顶椎下一椎体)凹侧肋骨长度显著大于凸侧(P<0.01),而上下端椎及非侧凸区两侧肋骨长度无显著性差异(P>0.05),RH为12.7°±4.0°;AIS组患者顶椎区(顶椎上一椎体、顶椎及顶椎下一椎体)凹侧肋骨长度也显著大于凸侧(P<0.01),其程度与Chiari畸形组无显著性差异(P>0.05),RH为11.9°±3.5°。顶椎区肋骨的不对称性与Cobb角大小呈显著性正相关关系(SSCM组:r=0.562,P=0.001;AIS组:r=0.463,P=0.003);与RH亦呈显著相关性(SSCM组:r=0.373,P=0.01;AIS组:r=0.328,P=0.02)。结论:SSCM患者主胸弯顶椎区两侧肋骨长度不对称,且不对称程度和剃刀背畸形相关,其不对称性特征与AIS患者一致,其可能是脊柱侧凸在生长期发病后的继发性改变。     

Comparison of ultrasonography and radiography in diagnosis of rib fractures

Purpose: Rib fractures are the most common skeletal thoracic injuries resulting from blunt chest trauma. Half of the rib fractures are not detected upon a precise physical evaluation and radiographs. Recently ultrasonography (USG) has been investigated to detect rib fractures. But based on literature the usefulness of USG varies widely. This study was conducted to investigate the role of USG in the detection of possible rib fractures in comparison with radiography. Methods: In this cross-sectional study, consecutive patients with minor blunt chest trauma and suspected rib fractures presenting in Imam Reza Hospital located in Mashhad-Iran, between April 2013 and October 2013 were assessed by USG and radiography. The radiography was performed in a posteroanterior (PA) chest projection and oblique rib view centered over the area of trauma. The time duration spent in taking USG and radiography were recorded. The prevalence and location of fractures revealed by USG and radiography were compared. Results: Sixty-one suspected patients were assessed. The male to female ratio was 2.4:1 (43 men and 18 women) with a mean ± SD age of (44.3 ± 19.7) years. There were totally 59 rib fractures in 38 (62.3%) patients based on radiography and USG, while 23 (37.7%) patients had no diagnostic evidence of rib lesions. USG revealed 58 rib fractures in 33 (54.1%) of 61 suspected patients and radiographs revealed 32 rib fractures in 20 (32.8%) of 61 patients. A total of 58 (98.3%) rib fractures were detected by USG, whereas oblique rib view and PA chest radiography showed 27 (45.8%) and 24 (40.7%) rib fractures, respectively. The average duration of USG was (12 ± 3) min (range 7e17 min), whereas the duration of radiography was (27 ± 6) min (range 15-37 min). The kappa coefficient showed a low level of agreement between both USG and PA chest radiography (kappa coefficient=0.28), and between USG and oblique rib view (kappa coefficient=0.32). Conclusion: USG discloses more fractures than radiography in most patients presenting with suspected rib fractures. Moreover USG requires significantly less time than radiography.     

Periosteal chondroma of the rib possibly associated with hemothorax: a case report

We report on a case of spontaneous hemothorax occurring in a 13-year-old boy with periosteal chondroma of the rib. Periosteal chondromas are rare, particularly in the ribs. To the best of our knowledge, this is the first report of periosteal chondroma of the rib associated with hemothorax.     

Carpal osteomyelitis in an intravenous drug user

The authors reported one case of carpal osteomyelitis in a female drug user. Treatment entailed intravenous antibiotics and early physiotherapy. Carpal osteomyelitis is uncommon, but intravenous drug users are mainly affected.