We herein report a case of isolated hip pain in a four year old boy. The importance of this project is the unusual history, presentation, ultrasound, MRI and blood culture results and treatment, which lead to the diagnosis of adductor pyomyositis with a rare organism (Streptococcus Mitis) in a temperate country. The patient presented with a one day history of malaise, fever, left groin pain and inability to weight bear on the left leg. There was no history of any predisposing infections or recent travel. A working diagnosis of transient synovitis / septic arthritis of the hip was made on clinical examination. Plain radiograph and ultrasound of the hip was normal with no effusion. Two consecutive blood cultures suggested Streptococcus Mitis bacteriaemia and MRI scan confirmed pyomyositis of the left hip adductors that was too small to drain. Streptococcus Mitis is a normal commensal organism of the oral cavity however it can lead to opportunistic infections particularly endocarditis. Echocardiogram revealed no cardiac complications, in particular no endocarditic vegetation. Patient was treated with intravenous benzylpenicillin for a week followed by oral phenoxymethylpenicillin for a week. As it was a soft tissue infection, a short course of antibiotics was sufficient and he made a complete recovery. Adductor pyomyositis must be considered as a differential diagnosis in a child with unusual presentation of hip pain. When an ultrasound is normal, MRI scan is warranted to confirm diagnosis. Septic screen should include blood cultures. The commonest organisms are the Staphylococcus family. However if Streptococcus Mitis is isolated, cardiac sources of infection resulting in septic emboli must be investigated. Repeated MRI scans are required particularly if the patient does not respond to medical management

The purpose of this study was to assess the impact of Ilizarov frame fixation and total contact casting on the complications of Charcot arthropathy. The diabetic charcot foot or ankle is a potentially limb threatening disorder. This progressive disorder is characterised by osteopenia, bone fragmentation and joint subluxation. The risk of significant deformity and osteomyelitis lead to high rates of amputation in these patients. We analysed patients with acute charcot arthropathy attending the Rowley Bristow Unit between 2008 and 2012. We assessed 48 patients with a mean age of 59 years. Mean follow up was 24 months. 12 patients were managed with Ilizarov frame fixation and 36 using total contact casting. The duration of management was determined using serial infrared temperature monitoring to ensure the temperature of the limb normalised before patients were deemed safe to remove their immobilisation. The mean duration of Iliazarov frame fixation was 6.2 months and 5.3 months duration for total contact casting. In the Ilizarov group pin site infections were common and treated with a short course of antibiotics. In total one patient required below knee amputation following Ilizarov frame fixation. No patients suffered with osteomyelitis. We feel that prompt management of acute charcot arthropathy with either total contact casting where appropriate or Ilizarov frame fixation can reduce serious complications of this disorder

We present a series of 11 patients with infected tibial intramedullary nails which were treated at our tertiary referral centre from January 2000 to November 2009. All of them were males and the mean age was 36 years (26 to 47 years). All the patients had sustained post traumatic fractures which were treated with intramedullary nail. Four patients (36%) had sustained open fractures in whom adequate soft tissue cover was provided by plastic surgeons. Five of them (45%) were smokers. All of them underwent surgical debridement. Nine out of 11 patients had removal of metal work followed by one or more of the following procedures such as reaming, exchange nailing, excision of sequestrum, application of antibiotic beads and stabilisation with a frame with or without several bone grafts at a later date. Out of 11 patients six (55%) had no further episodes of infection, three (27%) still need short courses of antibiotics when the disease flares up and two (18%) underwent amputation. Causative organisms were isolated in all the patients. Commonest organism was MRSA. Overall, most of the organisms were sensitive to Vancomycin and resistant to Penicillin. Despite exploring most of the surgical procedures described for infected tibial intramedullary nails we have potentially eradicated infection only in about half of our patients. Hence we would like to emphasise that this condition still remains a serious problem and demands further insight in its management

Little information is available about several important aspects of the treatment of melioidosis osteomyelitis and septic arthritis.

We undertook a retrospective review of 50 patients with these conditions in an attempt to determine the effect of location of the disease, type of surgical intervention and duration of antibiotic treatment on outcome, particularly complications and relapse.

We found that there was a 27.5% risk of osteomyelitis of the adjacent bone in patients with septic arthritis in the lower limb. Patients with septic arthritis and osteomyelitis of an adjacent bone were in hospital significantly longer (p = 0.001), needed more operations (p = 0.031) and had a significantly higher rate of complications and re-presentation (p = 0.048).

More than half the patients (61%), most particularly those with multifocal bone and joint involvement, and those with septic arthritis and osteomyelitis of an adjacent bone who were treated operatively, needed more visits to theatre.

Cite this article: Bone Joint J 2015;97-B:277–82.