Objective: To study MSCT-semiotics of anatomical and X-ray morphological changes in foot bones in patients with diabetic arthropathy complicated by chronic osteomyelitis to substantiate the role of MSCT in preoperative planning.
Materials and methods: Single center retrospective study. Series of cases. X-ray data, MSCT (multi-slice computed tomography) before treatment were studied in 30 patients with diabetic arthropathy complicated by chronic osteomyelitis.
Results: The results of the work showed that a violation of the structure of the cancellous bone occurred in all patients with varying degrees of severity, depending on the nature and location of the destruction of the bones of the foot. The total density of the cancellous bone of the distal tibia, talus, and calcaneus was higher than normal, the local density varied significantly and was maximum at some points of the subchondral tibia and talus, and the minimum was in the intertrabecular zones of the calcaneus and distal tibia. Arterial mediacalcinosis was detected by MSCT in 13 out of 30 patients.
Conclusion. MSCT, as one of the most objective methods for qualitative and quantitative assessment of the bone condition, allows obtaining data on the anatomical and topographic relationships of the bones of the foot and ankle joint, taking into account the possibility of data processing in three planes and during VRT, which is extremely important for studying the foot in diabetic patients. arthropathy complicated by chronic osteomyelitis. The method allows assessing the density of all foot bones in Hounsfield units and determining the severity of osteoporosis.

Background: Tuberculosis presents with late features like articular destruction, muscle wasting, contractures, deformity. Uncontrolled diabetes lead to chronic infections /morbidity. Methodology: Case Report Knee tuberculosis with rare presenting features. 74 year old man presented to ER with diabetic keto acidosis (TLC 6000, neutrophils 64 % ). He was non-diabetic previously- DKA was the first presentation (HbA1C 15). Urine, blood, sputum cultures showed no growth. From 2nd day he complained of right knee pain with hamstring spasm . Symptoms increased -pain on motion, knee held at 30 degrees flexion, marked effusion (6thday). Purulent aspirate was drained. Staining and culture was negative, arthrocentesis showed leukocytosis and raised CRP. Re-aspiration showed similar reports . Fibrotic synovial pouch, synovial fronds were noted (USG ) . Fatigue, weight loss (6 kgs ), anorexia , anemia were noted with no palpable lymph nodes . Inflamed synovium was palpable . CBNAAT came negative, X-ray showed hamstrings swelling .Permanent Pacemaker prevented MRI. Biopsy was put on hold – considering chronic non healing wound. Pulmonologist diagnosed him as smear-negative /paucibacillary Tuberculosis. Patient was put on traction and strict non-weight bearing (8 weeks) followed by physiotherapy. Anti-tubercular therapy was started. Result: Recovered without deformity. Conclusion: Early detection of tubercular synovitis warrants strong clinical suspicion. Presentation is variable like presence of DKA in this case. Keywords: monoarticular tuberculosis, paucibacillary/smear negative , CBNAAT, Tubercular Synovitis

Introduction: The use of 18F-FDG-PET-CT in bone and joint infection is well established. PET-MRI has evolved, aiming to reduce ionized radiation and produce better soft tissue images. We aimed to analyze the soft tissue uptake on PET-CT and its ability to localize and describe any soft tissue collection and correlate these findings to the operative finding. Methods: A prospective study included 45 patients (40 males/5 females) with clinically proven appendicular chronic osteomyelitis. 18F-FDG-PET-CT was requested for all patients to analyze the extent of osteomyelitis, detect any soft tissue collection, and plan the debridement surgery. Images were analyzed, and soft tissue uptake was recorded (sinuses, skin, and intramuscular soft tissue collection). Intraoperative findings were also recorded. Results: Patients were operated on at a mean age of 34(7-73); the cause of injury was RTA (65%), followed by Fall from height (15%). Tibia was affected in half of the patients (49%), followed by the femur (29%) and humerus, fibula, ulna, and calcaneus. Cierny-Madder class was diffuse(49%), localized 27%), intramedullary(22%), and superficial in one patient(2%). 60% had infected non-united fractures, 27% had infected united, and 13% had intact bone (hematogenous OM). Mean SUVmax at infection site 7.75(2.53-21.14), PET-CT showed clear tracking sinuses in all patients and soft tissue intramuscular collection in five patients(11%). These findings were identical to the intraoperative findings, where soft tissue collections were evacuated, debrided, and sampled as standard. Conclusion:18F-FDG-PET-CT can map soft tissue collection with high precision; PET-MRI could have no added value; however, it still carries ionized radiation hazards.

Introduction: To compare the outcomes of minimally invasive techniques and open techniques in the surgical management of dorsolumbar and lumbar spinal tuberculosis (STB).Methods: Skeletally Mature patients (Age 18-60 years), with active STB involving thoracolumbar and lumbar region confirmed by radiology (X-ray, MRI) and histopathological examination were included in the study. The patients were divided in to two groups, Group A consisted of patients treated by MIS techniques and group B consisted of patients treated by open techniques. All the patients had a minimum follow-up of 18 months.Results: A total of 42 patients were included in the study. MIS techniques were used in 18 patients and open techniques were used in 24 patients. On comparison between the two groups, blood loss (234 ml vs742ml), and immediate post-operative VAS score (5.26 vs 7.08) were significantly better in group A, whereas kyphotic correction (160 vs 33.250) was significantly better in group B. Rest of the parameters like duration of surgery, VAS score, ODI score and number of instrumented levels did not show significant difference between the two groups.Conclusion: MIS stabilization when compared to open techniques, is associated with significantly less blood loss and improvement in immediate post-operative VAS scores. The MIS approaches can be used to achieve functional results similar to open techniques. However, MIS is inferior to open technique in kyphosis correction.

Study Design: Retrospective Cohort Study. Objectives: To formulate a comprehensive spinal TB score to guide decision-making in the management of adult thoracolumbar spinal tuberculosis. Methods: A survey was conducted amongst spine surgeons of our institute based on the experience of treating 151 patients of spinal TB with conservative or operative management. The data collected identified vital characteristics that independently influenced treatment decisions and formed the basis for the scoring system. The four components of the Comprehensive Spinal TB score are pain, vertebral destruction, kyphosis angle and neurological status. Points were assigned for each component based on the severity and the total points were used to formulate clinical management guidelines based on the cut-offs determined from the ROC curve. Functional outcomes were documented using ODI, VAS, MRC and Frankel scores throughout the treatment. Results: ODI, VAS, MRC and Frankel scores improved significantly pre and post-treatment. A score class of <5.5, 5.5 to 6.5 and >6.5 was established to guide the patient towards conservative, conservative/operative and operative management, respectively. Conclusion: Our TB scoring system is simple yet comprehensively encompasses vital clinico-radiological characteristics and symptom complex necessary for clinical decision-making in adult thoracolumbar spinal TB. The validity, reliability and reproducibility of this scoring system needs to be assessed through long-term studies in the future.

Introduction: The Covid-19 pandemic has significantly changed the infectious disease landscape, including bone and joint infections. Osteoarticular infections can have severe long-term consequences, impact joint condition, and cause lifelong disability. This study aims to identify the impact of the pandemic on the epidemiology of pediatric osteoarticular infections. Methods: Retrospective review of children treated for an osteoarticular infection during the winter season (September - March) from 2017 to 2023 has been done. All cases of septic arthritis, osteomyelitis and spondylodiscitis treated at 2 Parisian pediatric orthopedic centers are included - covering a catchment area of ​​approximately 8 million people. Results: We included 1400 patients treated over 6 winters. 57% of patients were treated for arthritis (24% hip, 28% knee, 9% elbow, 11% at the ankle, 5% shoulder, 23% other joint or multi-joint), 30% for osteomyelitis (19 % femur, 18% tibia, 12% wrist, 7% calcaneus, 44% other bone or multi-bone) and 2% for spondylodiscitis, the remaining 11% patients had a mixed presentation. Preliminary analysis shows a changing epidemiology. A decrease in infections (20%) was observed during the COVID-19, with an increase since winter 2022-2023 (30%) that is higher than in pre-COVID times. Discussion: The epidemiological presentation of pediatric osteoarticular infections is changing, and cases are increasing significantly since the end of the COVID-19 pandemic. Further analysis of pathogens is necessary to understand the changing pattern, and if a continued increase in coming years is to be expected. This study can help adapt treatment protocols. Data collection will be completed by July 2023.

Background: We analysed the clinical and radiological parameters influencing functional outcomes and neurological recovery in patients with cervicothoracic junction tuberculosis(TB). Methods: This was a retrospective analysis of 16 cases of cervicothoracic junction(CTJ) spinal tuberculosis; 11 patients were managed operatively, while five were managed conservatively. Patients' outcomes were assessed at one month, one year and yearly thereafter and included an analysis of multiple outcome scores, various radiographic parameters, and sensitivity or resistance to anti-tubercular therapy. Results: Patients averaged 25.94 years of age and typically had three-level vertebral involvement. They were followed up for a mean duration of 24 months, and the duration of anti-tubercular therapy averaged 17 months. Patients demonstrated clinical improvement in Japanese Orthopedic Association score and Neck disability index(P< 0.005) starting from one month following initiation of treatment which continued in subsequent follow-up, along with a change in radiological parameters consisting of mean segmental kyphotic angle from 18.98 degrees to 15.13 degrees, C2- C7 SVA from 16.13 mm to 22.61 mm, T1 slope from 22.80 degrees to 14.66 degrees, thoracic inlet angle from 75.35 degrees to 63.25 degrees, neck tilt from 51.81 degrees to 48.33 degrees and cervical lordosis from 4.66 degrees to -0.44 degrees. (P>0.05) at the end of one year. Conclusion: Tuberculous affection of the dynamic CTJ is a challenging scenario in clinical practice and its management involves consideration of disease extent, neurological status and effort towards restoration of normal alignment of spine in the sagittal and coronal plane to get favourable clinical outcomes.

Abstract
Background: In the treatment of chronic osteomyelitis, the common methods in primary stage are debriding, draining and lavaging, but the clinical outcomes are not always satisfactory1. Despite the variety of available treatment options of chronic osteomyelitis in children, including surgical procedures and antimicrobial therapy, bone infections are still a medical challenge as they are difficult to treat and cure.
Aim of the work: The goals of this treatment protocol are to eradicate infection, heal the ulceration/abscess/wound, and reduce or eliminate the need for intravenous antibiotics in the treatment of osteomyelitis and complex infections of the skin and soft tissue structures.
Patients and methods: From March 2012 to October 2015 a series of 17 chronic osteomyelitis in childern procedures were performed. All patients underwent surgical debridement followed by application of synthetic pure dissolvable calcium sulphate beads impregnated with antibiotics were employed.
Results and conclusion: The clinical outcome after six months amounted to successful treatment assessed as eradication of infection in 17 patients over the time of observation.

Background: Paravertebral abscesses are poorly understood. This prospective study aimed to investigate the association between the volume of paravertebral abscesses and various parameters, such as the number of involved vertebral bodies, dimensions of epidural abscesses, neurological deterioration, and drug resistance. Common interventions in the management of paravertebral abscesses were also documented. Methods: The study involved 51 patients with paravertebral abscesses. The abscess volume was calculated using an ellipsoid formula from MRI, and the correlation of the paravertebral abscess volume with various parameters was evaluated. Results: The mean paravertebral abscess size was 78.82 ml (SD= 177.12), with a mean of 3.52 (SD= 1.96) vertebral bodies involved. No significant association was found between the paravertebral abscess volume and the number of involved vertebral bodies (R2= 0.0023) or the dimensions of epidural abscesses (R2= 0.0284). There was also no significant difference in the paravertebral abscess size between patients with multidrug-resistant tuberculosis (MDR-TB) and non-MDR-TB patients (p= 0.306). Patients with neurodeficit had a smaller mean paravertebral abscess size (37.80 ml) compared to those without neurodeficit (121.48 ml) (p=0.1040). Percutaneous drainage was used in 9.8% of patients, with an average duration of 14.4 days (SD=5.59 days) and a mean abscess volume requiring drainage of 148.37 ml (SD=261.79 ml). Conclusion: This study found that there is significant variability in the morphological presentation of paravertebral abscesses in spinal tuberculosis. However, the size of the paravertebral abscess was not significantly associated with the number of involved vertebral bodies, dimensions of epidural abscesses, neurological status, or drug sensitivity.

Thoracolumbar spondylodiscitis is a serious condition that requires surgical intervention for removal of infected tissue and stabilization of the spine. The anterior and posterior approaches are the two main surgical options available, but the optimal approach for the treatment of thoracolumbar spondylodiscitis remains uncertain. A meta-analysis was conducted to compare the clinical outcomes of anterior and posterior approaches in surgical treatment of thoracolumbar spondylodiscitis. The meta-analysis included 17 studies with a total of 843 patients, and found no significant difference in surgical site infection rates between the two approaches. However, the anterior approach was associated with a longer operative time and greater blood loss than the posterior approach, with no significant difference in complications between the two approaches. The choice of surgical approach should be based on patient-specific factors, such as the location and extent of the infection, the presence of comorbidities, and the surgeon's experience and preference. Further research is needed to establish optimal patient selection criteria and to compare long-term outcomes of the two approaches.