Aim. The localization of sequestrum in chronic osteomyelitis (COM) is crucial in preoperative planning. The identification of sequestrum on plain X-ray could be difficult. CT and MRI were reported to show the sequestrum. We aimed to analyze the sequestrum characteristics on 18F-FDG-PET-CT images. Methods. A prospective study included all patients diagnosed with long-bone chronic osteomyelitis. All patients had preoperative 18F-FDG-PET-CT. Images were analyzed using RadiAnt DICOM Viewer. Axial cuts were used to measure the Standard Uptake Ratio (SUV)max in the Region of Interest (ROI) in the sequestrum, the surrounding area, and the normal bone in the same cut. Surgical debridement was done as standard; samples were taken for microbiology and histopathology, and the intraoperative finding was documented. Results. Nineteen patients (17 males/2 females) were operated on in one center between October/2021 and Jan/2023 at a mean age of 32±18. There were 10 tibias, 7 femurs, one ulna, and one fibula. Ten had postoperative COM, six open fractures, and three hematogenous OM. They all showed sequestrum on PET-CT; the dead bone appeared void, surrounded by a halo of increased uptake. There was a trend of lower uptake in the sequestrum compared to the halo around. The mean SUVmax at the sequestrum was 4.18±3.16, compared to the surrounding halo, 7.08±5.81. The normal bone has a mean SUVmax of 1.61±1.42. Sequestrum was removed successfully in all cases. Conclusion. 18F-FDG-PET-CT can precisely localize the sequestrum preoperatively, it has a lower uptake than tissues around it. This would facilitate planning and improve the quality of debridement

Radiographic follow-up of traumatic spondylolisthesis of the axis is well documented in the literature. However, there is a paucity of studies regarding the long-term functional outcome of this type of injury. To study the population, treatment and outcome following traumatic spondylolisthesis of the axis, we reviewed 36 consecutive patients presenting to our institution, a tertiary referral spinal trauma centre, over a 6-year period. We assessed: (a) the mechanism of injury, (b) the mode of treatment, (c) the radiographic classification using the Levine and Edwards system and (d) functional outcome using the Cervical Spine Outcomes Questionnaire (CSOQ) by BenDebba. Of the 36 patients presenting there were 24 males and 12 females with a mean age of 46 (range18-82) years. The commonest mechanism of injury was road traffic accidents. There were 14 Type-I, 11 Type-II and 1 Type-IIA fractures. Twenty-seven patients were treated with halo vest immobilisation and nine were immobilised in a Minerva jacket. Four patients were converted from halo to Minerva because of pin failure. The mean duration of hospital stay was 10 (range 3-30) days. All fractures demonstrated radiographic union at a mean of 12 (range 10-16) weeks. There were no neurological complications. Upon review, all patients, whether Type-I or Type-II demonstrated low CSOQ scores approaching their pre-morbid status. However, Type-II fractures scored higher in 3 functional outcome categories when compared to Type-I fractures. This unique study of an uncommon fracture shows for the first time a difference in the functional outcome scores of Type-II fractures of the axis when compared to Type-I fractures at a mean follow-up of 3 years and 10 months

In the knee, involvement is mainly synovial, with local extension eroding the bone. Pure tuberculous osteitis is rare, with a few occasional reports. Patella tuberculosis is extremely rare. We report the case of patella tuberculosis with 7-years decline. A 10-years old boy suffered from knee siftness and pain. The patient had correct BCG vaccination. Clinical examination was relatively unrevealing, with tenderness on palpation of the medial joint surface of the patella, patellar crepitation, and slight effusion. On standard X-ray, the lateral view showed a circumferential rosette form with a light peripheral halo. The patient underwent open surgery with a medial parapatellar approach and arthrotomy. Joint fluid was sampled. Direct exploration of the medial side of the patella found soft but continuous cartilage on palpation. The histoligical examination confirmed the diagnosis of tuberculosis. The patient had 12 month anti-tuberculosis chemotherapy. After 7 years of the treatement, the patient had no recurrence and good clinical result. Bone tuberculosis remains difficult to diagnose. Certain locations should always be borne in mind, however rare, in case of pandemic or immunodeficiency. In case of osteolysis, associated with abscess or not, infectious etiology is to be considered and appropriate samples should be taken. Diagnosis is confirmed by histology and bacteriology. The slow evolution of bone tuberculosis requires local treatment of lesions and abscesses. Antibiotherapy regularly ensures recovery

Aims

Bacterial infection activates neutrophils to release neutrophil extracellular traps (NETs) in bacterial biofilms of periprosthetic joint infections (PJIs). The aim of this study was to evaluate the increase in NET activation and release (NETosis) and haemostasis markers in the plasma of patients with PJI, to evaluate whether such plasma induces the activation of neutrophils, to ascertain whether increased NETosis is also mediated by reduced DNaseI activity, to explore novel therapeutic interventions for NETosis in PJI in vitro, and to evaluate the potential diagnostic use of these markers.

Odontoid synchondral fractures are considered the most common type of fracture, amounting TO 10% of all subaxial injuries in the under 7 demographic. This injury occurs as typically the result of hyperflexion. Most odontoid fractures in children below 7 years of age involves the odontoid synchondrosis. The following is a report of the management of paediatric synchondral fractures in 2 patients who presented to the Children's Hospital Westmead in 2010. Both patients had displaced synchondral odontoid fractures which were managed by indirect reduction and halo traction. In both patients an anatomical alignment was achieved and maintained. Follow-up was 6 and 9 months respectively and the patients were assessed both clinically and radiologically. We feel the use of the “double mattress” technique is a valuable tool, as a means of achieving and maintaining occipitocervical extension, necessary, in the treatment of odontoid synchondral fractures

Aims

The ongoing COVID-19 pandemic has disrupted and delayed medical and surgical examinations where attendance is required in person. Our article aims to outline the validity of online assessment, the range of benefits to both candidate and assessor, and the challenges to its implementation. In addition, we propose pragmatic suggestions for its introduction into medical assessment.

Adult presentation of neglected congenital muscular torticollis is rare. We report 12 patients with this condition who underwent a modified Ferkel’s release comprising a bipolar release of sternocleidomastoid with Z-lengthening. They had a mean age of 24 years (17 to 31) and were followed up for a minimum of two years. Post-operatively a cervical collar was applied for three weeks with intermittent supervised active assisted exercises for six weeks. Outcome was assessed using a modified Lee score and a Cheng and Tang score. The mean pre-operative rotational deficit was 8.25° (0° to 15°) and mean lateral flexion deficit was 20.42° (15° to 30°), which improved after treatment to a mean of 1.67° (0° to 5°) and 7.0° (4° to 14°) after treatment, respectively. According to the modified Lee scoring system, six patients had excellent results, two had good results and four had fair results, and using the Cheng and Tang score, eight patients had excellent results and four had good results.

Surgical management of adult patients with neglected congenital muscular torticollis using a modified Ferkel’s bipolar release gives excellent results. The range of neck movement and head tilt improved in all 12 patients and cosmesis improved in 11, despite the long-standing nature of the deformity.