Background : Osseous ecchinococcosis is uncommun, rendering its diagnosis challenging and confusing with other diseases such as bone tumors. This work aims to display the difficulties in diagnosing such condition. Observation : A 54-year-old farmer has been experiencing mixed mechanical and inflammatory pain in the left knee for 2 months. Clinical examination reveals a complete but painful range of motion of the knee. Standard radiography and MRI results show a heterogeneous osteolytic metaphyseal-diaphyseal distal image spanning a length of 33 cm, with medial periosteal reaction. Biopsy of the distal femoral metaphysis, performed under lateral crural approch, confirmed the diagnosis of osseous echinococcosis. Discussion : The atypical appearance of hydatid cyst on MRI added to the diagnosis challenge, particularly in presence of lytic bone lesions and periosteal reaction. This unusual presentation could easily be mistaken for other conditions such as primary or metastatic bone tumors, infection and even inflammatory bone diseases. Conclusion : This case underscores the importance of acknowledging the diagnostic difficulty associated with osseous echinococcosis, especially when interpreting MRI findings that may deviate from typical presentations. A holistic approach, including a detailed medical history, thorough clinical examination, and careful interpretation of imaging studies, is essential for achieving an accurate diagnosis and initiating appropriate treatment in a timely manner.

Introduction: Infective bone defect treatment in fractures is a challenge in modern orthopaedic surgery. Alain Masquelet described a 2-stages procedure in which a membrane is induced and formed around the bone defect. Using this technique, Masquelet and others described complete bone healing and restoration of limb function in several clinical cases. Case Report: A 47-year-old female patient who presented with pain, swelling, and a discharging sinus over her Right arm for 20 days following a road traffic accident resulting in a Fracture shaft of right Humerus managed with open reduction internal fixation with plate osteosynthesis. Immediate post op she developed discharging sinus and was subsequently diagnosed with an infected implant with implant failure. Patient underwent Emergency wound debridement with excision of avascular infected bone and external fixator application with appropriate antibiotic therapy. Patient had persistent discharge over the surgical site necessitating a secondary wound debridement with customized antibiotic cement spacer made with 20 cc syringe. After 2months patient underwent procedure for antibiotic spacer and fixator removal with plate osteosynthesis with Fibular strut and Iliac graft. Result: Patient was followed up for 2 years with no functional disability and return to her daily activities. Conclusion: This case highlights the challenges encountered in the management of complex surgical site infections with a multi-stage approach by Modified Masquelet technique and a customized antibiotic cement spacer using 20cc syringe for cylindrical shape of the humerus.

Introduction: Tubercular-spondylodiscitis is a common infection in developing nations. It presents as chronic backache, with/without constitutional symptoms and neurological deficit. The treatment constitutes medical management with anti-tubercular therapy for 12-24 months depending on the sensitivity pattern, with surgical management being reserved for complications like increasing kyphosis, instability, or progressive neurodeficit. On radio-pathological examination, two predominant forms are known – the dry and the wet type. Wet forms have abscess formation as their predominant radiological presentation, whereas dry forms include caseation and sequestration with minimal exudation. We hypothesize that patients with dry lesions, even without significant mechanical compression, show poor neurological recovery even with surgical management, in addition to anti-tubercular therapy. Methods: Single-centre patient data of 6 years was analyzed and a retrospective, observational cohort study was performed. Out of 217 patients, 18 patients with dry Koch’s spine (Group 1) and 27 patients with wet Koch's spine (Group 2) were found, and their clinico-radiological parameters were compared. Results: Dry variety showed partial or no return to ambulation (55.5%, versus 14.8% in wet) at 12 months, and took more time to reach the final ambulatory level, despite having a lesser average Cobb’s angle (17.37 degrees, versus 28.99 degrees in wet), lesser mean canal-encroachment (28.33%, versus 43.62% in wet) and preserved posterior-CSF flow as compared to wet-type (p<0.05). Conclusion: Dry lesions of tuberculous-spondylitis are likely to have a poor functional outcome, possibly due to vasculitis or tubercular myelitis, rather than isolated mechanical compression, leading to neurological deficit non-responsive to therapy.

Spinal tuberculosis, a form of extrapulmonary tuberculosis affecting the spine, has reemerged as a significant medical challenge in recent years. This reemergence can be attributed to factors such as increased global travel, migration, HIV co-infection, and the emergence of drug-resistant strains of Mycobacterium tuberculosis. Pain throughout the spine, neurological impairments, and deformities are some of the signs of spinal tuberculosis, which can cause serious morbidity if left undiagnosed and untreated.
Because of the nonspecific symptoms and the requirement for a high index of suspicion, early diagnosis is still a major difficulty. The diagnosis of spinal tuberculosis is greatly aided by imaging modalities such as MRI, which make hallmark signs like spinal cord compression, paravertebral abscess formation, and vertebral degradation visible. Generally, patients get treatment for a long time with a mixture of antitubercular medications; in cases of severe deformity or neurological damage, surgery is frequently included as a complement.
Improving diagnostic methods, raising public awareness, and guaranteeing access to high-quality medical care are all part of the fight against spinal TB, particularly in areas with low resources.
Efforts to combat spinal tuberculosis include improving diagnostic algorithms, promoting public awareness, and ensuring access to quality healthcare services, especially in resource-limited settings. Collaboration between healthcare providers, researchers, and policymakers is essential to effectively address this reemerging threat and reduce its impact on global health.
We’ve conducted a literature review of spinal tuberculosis papers in Pubmed, Google Schollar and NCIB from 2016 to 2023.

Introduction: MRI is the best exam for analysing the intervertebral disc and detecting disco-vertebral infections. In some cases, MRI can lead to a false diagnosis. Presentation of the case: A 28-year-old man presented with progressively right L5 lumbosciatica, resistant to medical treatment, with no sensory-motor deficit. MRI was consistent with an intraspongiosa herniation of the superior plateau of L5 with a right paramedian L4-L5 disc herniation. The patient underwent a hemi-laminectomy L5. Intraoperatively, we noted a discharge of pus and the presence of infected tissues; intraoperative samples were negative. At one month post-operatively, the evolution was marked by the appearance of a swelling opposite the operative scar with reappearance of low back pain. MRI showed the appearance of infectious SPD at L4L5 and L5S1, with multiple epidural collections, one of which extended subcutaneously. The patient was taken for surgical drainage of the collection. PCR was positive for Mycobacterium tuberculosis. The patient was put on anti-tuberculosis treatment with a good clinical-biological evolution. Discussion: The radiological diagnosis of disco-vertebral infections is based essentially on MRI. Gadolinium injection increases the resolution of MRI and generally makes it possible to distinguish an infectious process from degenerative phenomena. Furthermore, in some cases, for Modic type 1 vertebral plateau signal changes, bone oedema gives a hypo-signal T1 and hyper-signal T2 appearance. These changes are not specific and may be difficult to differentiate from an infectious process. Some authors suggest disco-vertebral puncture to distinguish between a disco-vertebral infection and a degenerative process.

Introduction: To evaluate the feasibility, efficacy and safety of debridement and fusion combined with short-segment screws and rod fixation through anterolateral mini-access for treatment of thoracic or lumbar infection. Methods: 48 patients with single segment thoracic or lumbar infection from December 2019 to January 2022 were included. There were 42 cases of tuberculosis (TB), 2 cases of brucellosis, 4 cases of escherichia coli. They underwent the fusion using cortical iliac bone, titanium mesh or cage abscess and short-segment screws and rod fixation through anterolateral mini-access after the abscess, infected and necrotic tissue were completely removed under direct vision. Operative duration, blood loss, incision length and hospital stay were recorded. Pre- and postoperative visual analog scale (VAS) pain scores, Oswestry disability index (ODI), complications and images were also recorded. Results: There were blood loss of 280(35-450) ml, operative duration of 173(95-206) min, incision length of 52±11cm and hospital stay of 6(4-8) days. VAS scores significantly dropped postoperatively (P<0.001) and ODI significantly decreased 2 years after surgery (P<0.001). No complication was found. Conclusion: Debridement and fusion combined with short-segment screws and rod fixation through anterolateral mini-access is a feasible, efficient and safe method in treating single segment thoracic or lumbar infection. It shows advantages of less surgical trauma and faster postoperative recovery.

A retrospective study was conducted on 32 patients with Brucella spondylitis between January 2015 and December 2022 at the Third Affiliated Hospital of Southern Medical University in Guangzhou of China. All the data was analysed including their medical history, clinical manifestations, laboratory indicators, imaging data, bacterial culture results, treatment plans and follow-up outcomes. We found that a low diagnostic rate of Brucella spondylitis was demonstrated in non-epidemic areas, especially in grassroots hospitals. Patients in these areas shared similarities with those in epidemic areas in terms of age, gender ratio, and urban-rural sources. However, there were differences in infection risk factors. In non-epidemic areas, foodborne infections were predominant (71.87%), with a relatively high proportion of non high-risk occupational groups (62.50%). Inflammatory pain (96.88%), neurological symptoms (50.00%), and fever (37.50%) were the most common clinical symptoms, with fewer fever cases and atypical intermittent fever. The positive rates of blood culture (54.5%) and lesion puncture culture (55.56%) were not particularly high. MRI examination is crucial for early diagnosis and differential diagnosis of diseases. The lumbar spine (56.25%) and lumbosacral region (18.75%) were most commonly affected, with a relatively mild degree of intervertebral space stenosis. It has been shown that conservative treatment was not only effective in many cases, but also reduced the economic burden on patients. Besides, surgical intervention was considered necessary, for patients with worsening symptoms of spinal cord/nerve compression as well as spinal instability caused by vertebral destruction.

Introduction: Anterior approach to the upper thoracic spine serves as an advantage in direct access to the lesion, decreased intra-operative bleeding, lowering the risk of infection and eliminating use of posterior or combined approaches. Isolated anterior approach should be chosen very selectively to deal with upper thoracic pathology as it is a non-extensile approach. We retrospectively looked at patient’s with lesions involving T1 to T3 levels which were approached anteriorly. Methods: Retrospective study of 4 patients who underwent surgery of pathology in T1 to T3 vertebrae. Inclusion criteria: Pathology of T1 to T3 vertebrae, symptomatic and radiological evidence of cord compression. Exclusion criteria: Lesions involving C7-T1. Discussion: Our observations were that the approach was quick, bloodless and allowed good vision of the pathology of the spinal cord. However patient selection with respect to thoracic kyphosis, level of the sternum in relation to the pathology, orientation of the affected disc in relation to the vertical and versatile implant availability were key to achieve a successful result.

Backround: Artisanal coated intramedulary standard nails with a layer of antibiotic cement were used for osteosynthesis of the tibia or femur that had septic non-unions: case report series. Objectives To cure the septic non union, and mal-alignment with cement-antibiotic coated crafted nails in septic diaphyseal non-union of the tibia and femur. Methods: We operated 12 cases with tibial or femoral septic non-union. Four cases had severe malalignment (10 degrees-30 degrees). After debridement and reaming of the bone in excess by 4 mm thicker than the desired nail diameter, we performed the synthesis with cemented nails. We manually coated the intramedullary standard nails with a layer of antibiotic cement, efficient for the patient germs. In the cement, in 9 cases we added Vancomycin 2 g / dose and in 3 cases we used standard Erythromycin and Gentamicin cement. In 10 cases we were able to lock the cemented crafted nail. Results: Healing of the nonunion was achieved in all cases and restoration of alignment was obtained in 11 cases. In 4 cases we have added hydroxyl apatite locally preloaded with Tobramycin. Clinical and laboratory criteria confirmed the absence of sepsis. We were confident to extract the implant in only 4 cases. Conclusions: Good results have been obtained with this cement-antibiotic coated crafted nails in septic diaphyseal non-union of the tibia and femur. The one-step surgery managed to solve the non-union, septic, and malalignment. Our experience is limited, but in the future, it could be a valuable method.

Introduction: Tuberculosis (TB) infections of the musculoskeletal system are uncommon. While it may affect any joint,, TB of the elbow is a rare condition, particularly as the presenting symptom. Results: A 47-year-old man visited urgent care multiple times over 2 months with atraumatic elbow pain. Physical examination revealed swelling and skin ulceration with sero-hematic discharge. The patient had no history of consumptive symptoms and had not recently traveled. Laboratory findings showed negative leukocytosis and CRP. Imaging displayed extensive signs of bone destruction. An open arthrotomy with irrigation and debridement was performed. Histological and bacteriological examination confirmed osteomyelitis caused by tuberculosis. The patient followed a standard first-line oral regimen for extrapulmonary TB for a year. Two years later he reported clinical improvement and had resumed his professional activity with a satisfactory range of motion. Discussion/Conclusion: Elbow TB is insidious and delayed diagnosis leads to cartilage destruction, progressive joint deterioration and ultimately subluxation and ankylosis.One of the primary challenges lies in the differential diagnosis of chronic atraumatic elbow pain. Besides infection, a wide array of more common pathologies, such as inflammatory, autoimmune, or even tumoral conditions, must be considered. Furthermore, TB represents an uncommon infectious etiology, especially in non-endemic areas, with elbow arthritis serving as an unusual initial presentation. Anti-TB drugs are the mainstay of treatment; nevertheless appropriate surgical interventions may be required. This case underscores the importance of considering TB as a potential diagnosis: early recognition and prompt management are paramount in preventing complications and improving patient outcomes.

Abstract: Bone metabolism disorders are important pathophysiological component of chronic osteomyelitis (OM), including OM of the long bones. Gram-positive and gram-negative pathogens influence bone remodeling in a large spectrum of ways. Study of metabolic changes of the bone tissue in patients with OM is important for developing proper treatment strategy. Methods: 112 adult patients participated in a randomized cohort study. Both groups (control and main group, each N=56) received operative treatment of chronic osteomyelitis of long bones (humerus, femur, tibia) with antibiotic therapy. The main group received etiotropic metabolic disorders therapy according to laboratory test results. Bone metabolism was evaluated 1 week before treatment and 3 months postop, as follows: blood calcium, ionized calcium, phosphates, parathyroid hormone (PTH), 25-hydroxy-vitamin D, bone alkaline phosphatase, osteocalcin, b-cross-laps; urine calcium, phosphates, resorption marker DPID deoxypyridinium (DPD) to creatinine ratio (DPD/Cre ratio). Statistical comparison was made using IBM® SPSS Statistics 26 using Mann-Whitney U-test. Bone metabolism markers and consolidation time were evaluated. Results: in main group higher levels of osteocalcin were discovered (p=0.043), as well as lower PTH levels (p=0.043) and lower DPD/Cre ratio (p=0.041). Consolidation time for all anatomic segments was lower in the main group (humerus: 0.041; femur: 0.009; tibia: 0.041). Results indicate that during treatment the elevated bone resorption is partially inhibited towards physiological level, helping to preserve bone tissue during infection process. Metabolic disorders therapy can be considered an important part of complex treatment of chronic osteomyelitis of long bones.