Case Report Neurosurg Focus 17(6), 2004 Posted 01/18/2005 John W. German, M.D.; Susan M. Kellie, M.D.; Manjunath P. Pai, Pharm.Dc.; Paul T. Turner, M.D.
Scedosporium apiospermum is a rare cause of fungal vertebral osteomyelitis that may result in chronic infection requiring multiple surgical interventions and long-term medical therapy. This case is the seventh one reported in the literature and is the first to include salvage surgery of a previous major spinal reconstruction. This report is also the first to describe the use of the new antifungal agent voriconazole. In treating this case of chronic vertebral osteomyelitis, several principles are emphasized from both the surgical and medical perspectives. From a surgical perspective, the use of salvage surgery, temporary avoidance of spinal instrumentation, and an appropriate choice of graft materials are emphasized. From a medical perspective, confirmation of the diagnosis, the need for long-term antifungal therapy, the need for long-term patient compliance, and the use of the new antifungal agent voriconazole are emphasized. Application of these principles has led to an adequate 2-year outcome.

Radiology case 462-23 Clinical presentation: Swelling and discomfort in the left ankle in an adult male from India.

Radiology case 458-23 Clinical presentation: Gradual onset of pain and swelling in the left knee in a 30 year old man, originally from India.

Journal of Orthopaedic Surgery 2001, 9(1): 57–60 Jitendra Mangwani, Anil Kumar Gupta, CS Yadav and KS Rao Central Institute of Orthopaedics, Safdarjang Hospital,New Delhi, India
ABSTRACT Tuberculosis of the shoulder joint is uncommon. In adults the classical dry type of shoulder tuberculosis (caries sicca) has been described, while the fulminating variety has not been reported. We treated a case of fulminating variety of tuberculosis of the shoulder joint with anti-tubercular therapy and a shoulder immobilizer sling. At 18 months of follow up, the patient was disease free and had a good functional range of motion.

Journal of Orthopaedic Surgery 2003: 11(1): 73–79 SP Mohanty, MN Kumar, NS Murthy Department of Orthopaedics, Kasturba Medical College, Manipal 576 119, Karnataka, India
ABSTRACT Purpose. To assess the use of antibiotic-loaded polymethyl methacrylate beads in the management of chronic osteomyelitis of different aetiologies: in- fected osteosynthesis, infected open fractures, and haematogenous osteomyelitis. Methods. Records of 49 patients with chronic osteomyelitis who were treated at Department of Orthopaedics, Kasturba Medical College, from 1995 to 1999 were studied retrospectively. The diagnosis of chronic osteomyelitis was made on the basis of clinical and radiographic features. Of the 49 patients, 4 had haematogenous osteomyelitis, which later proved to be tuberculosis, and were thus excluded. Antibiotic- loaded acrylic beads were implanted in the remaining patients after thorough debridement. The implant was removed primarily in 16 patients with infected osteosynthesis, who then underwent decompression and sequestrectomy. All wounds were closed primarily. Peri-operative antibiotics were given for 7 days. Beads were removed at the end of 3 weeks followed by bone grafting in 26 patients. Patients were followed up for an average period of 3.7 years. Results. The infective organisms were sensitive to gentamycin in 26 cases and resistant in 19 cases; 14 cases were sensitive to cefuroxime, 11 to cloxacillin, 8 to ampicillin, and 5 to cotrimoxazole. Seven cases were resistant to all antibiotics tested. Of the 19 patients with gentamycin-resistant infection, only one had a poor result. No adverse systemic side-effects such as ototoxicity or nephrotoxicity were seen. Infection did not recur in 39 patients, but 6 patients had low-grade persistent infection at the last follow-up visit. Conclusion. In chronic infections, especially those following osteosynthesis, antibiotic beads are a valuable adjuvant. The most valuable advantage is that the wound can be closed primarily, thereby reducing the incidence of nosocomial infections and requirement of nursing care.