UNASSIGNED: Acute scapular osteomyelitis is an exceptional entity with a misleading clinical presentation. If not urgently diagnosed and treated correctly, it may lead to articular surfaces damage, deformation of the humeral head, and humerus shortening.
METHODS: A 12-year-old boy without any medical history with osteomyelitis of the scapular neck complicated with secondary septic arthritis of the gleno-humeral joint was evaluated. Through a posterior surgical approach, a large washout and articular drainage were performed. In the last follow-up visit 18 months later, the functional result was satisfactory: complete loss of pain, good shoulder mobility, and no anatomical anomalies were noted.
UNASSIGNED: The most frequent site of hematogenous acute osteomyelitis is the long bones\' metaphysis. Flat and short bones are rarely involved. The delayed diagnosis can be explained by unusual clinical presentation, so clinicians should point their reflections towards this particular entity because an early diagnosis as well as early treatment is crucial in order to achieve a satisfactory anatomical and functional result. Late diagnosis can be the cause of articular surface damage, and the involvement of the proximal humerus may lead to deformation of the humeral head. Early diagnosis and urgent treatment are the key combination for a satisfying outcome.
CONCLUSIONS: Acute osteomyelitis of the scapula requires specific surgical management to avoid any further complications, especially in children. We call attention to the importance of both urgent medical and surgical treatment for a better functional and anatomical outcome.

Background and Objectives: Hand septic arthritis is a potentially debilitating condition that can significantly affect patient functionality and quality of life. Understanding the demographic, clinical, and microbiological characteristics of this condition is crucial for its effective treatment and management. This study aimed to analyze the demographic and clinical profiles of patients with hand septic arthritis, to identify common microbial pathogens, and to evaluate the impact of various factors on clinical course and treatment outcomes. Material and Methods: This cross-sectional retrospective study examined patients diagnosed with septic arthritis of the hand, focusing on their demographic data, clinical presentation, causative organisms, treatment methods, and outcomes. Data on age, sex, cause of infection, affected sites, surgical interventions, microbiological findings, and patient outcomes were also collected. Results: This study found a higher prevalence of septic arthritis in males and identified bite as the predominant cause. Staphylococcus aureus is the most common pathogen. A large number of patients did not exhibit bacterial growth, and bacterial resistance did not significantly affect the outcome. Outcomes were statistically influenced by the timing of medical presentation and the presence of comorbidities. Conclusions: Early diagnosis and intervention are critical for effective management of hand septic arthritis. This study underscores the need for a comprehensive approach that considers patient demographic and clinical characteristics to optimize treatment outcomes. Awareness and preventive measures are essential to reduce the incidence and severity of this condition.

UNASSIGNED: Septic arthritis is an orthopedic emergency. Diagnosis is difficult in patients with concomitant crystalline arthropathy (gout or pseudogout). The symptomatology of crystal arthritis mimics septic arthritis, clouding clinical diagnosis. Arthrocentesis and synovial fluid analysis are the standard diagnostic tests for both pathologies. Crystals on microscopy are diagnostic of crystal arthritis, however their presence does not rule out septic arthritis. Septic arthritis is diagnosed by positive microbiology culture. Though septic arthritis is associated with elevated synovial total nucleated count (TNC), TNC elevations can also occur with gout. The literature suggests that a TNC count of > 50,000 cells in a crystal-positive joint should raise suspicion for concurrent septic arthritis, however data is limited. Further diagnostic indicators are needed to help clinicians promptly identify crystal positive septic arthritis as the treatments and prognoses are different.
UNASSIGNED: Patients were retrospectively identified who had arthrocentesis of a native joint positive for monosodium urate (MSU) and/or (CPPD) crystals. Laboratory data was collected including synovial fluid cultures, total nucleated cell count (TNC), percent polymorphic neutrophils (%PMN), and crystal analysis; and serum CRP, ESR, and white blood cell count (WBC). Statistical analysis performed using Spearman correlation, Univariate-Fischer\'s exact and Wilcoxon tests, and multivariate analysis.
UNASSIGNED: 442 joints identified with positive CPPD and/or MSU crystals, 31% female, 69% male. Of 442 aspirates, 58 had positive cultures. Patients were more likely to have positive cultures if synovial TNC > 50,000 (odds ratio 7.7), CRP > 10 mg/dL (OR 3.2), PMN > 90% (OR 2.17), and if the patient was female (OR 1.9), all were statistically significant with p < 0.05. There were 55 patients who underwent irrigation and debridement based on clinical suspicion or a positive gram stain, 37 of these ultimately had a positive culture (67%), the remaining 18 had negative cultures.
UNASSIGNED: Results are consistent with the literature, a TNC > 50,000 warrants a high suspicion for concurrent septic arthritis and should prompt providers to critically evaluate other patient laboratory data. Results further suggests that a patient with positive crystals, synovial TNC > 50,000 cells, PMN > 90%, and serum CRP > 10mg/dL is at high risk for having a concurrent septic arthritis and may warrant urgent irrigation and debridement and antibiotic therapy. This data serves as a supporting to develop an infection risk calculator for crystal positive septic arthritis. Level of Evidence: III.

Introduction Musculoskeletal (MSK) infections are prevalent in the pediatric population, with previous research highlighting the significant impact of socioeconomic status (SES) on treatment outcomes. However, the specific link in pediatric cohorts remains poorly understood. The Area Deprivation Index (ADI), a measure of neighborhood-level disadvantage, serves as a crucial marker for SES. This study aims to investigate how ADI influences disease characteristics, treatment delays, and outcomes in pediatric patients with MSK infections. Methods A single-center retrospective cohort analysis was conducted using patient charts from a large urban pediatric hospital over six years from 2017 to 2022. Patients aged 0-18 years with diagnoses of osteomyelitis, septic arthritis, cellulitis, or pyomyositis were identified using the International Classification of Diseases - 10th Revision (ICD-10) codes. Data collection included demographics, disease characteristics, treatment delay intervals, and complications. Patient zip codes were obtained and entered into the Neighborhood Atlas® mapping website to determine their ADI. Patients were then stratified into four groups based on ADI scores: 1-10, 11-20, 21-40, and 41-100. Statistical analysis included the use of the Mann-Whitney U test for continuous data and the Chi-square/Fisher\'s exact test for binary and categorical data comparisons among the ADI groups. Results A total of 121 patients were included. Categorization based on ADI revealed 25 (20.7%) patients in the 1-10 ADI percentile group, 36 (29.8%) in the 11-20 group, 38 (31.4%) in the 21-40 group, and 22 (18.2%) in the 41-100 group. There were no significant differences between ADI and patient demographics, disease characteristics, presentation delay interval, treatment received, and complications. Conclusion The study demonstrates that there was no significant difference between ADI groups regarding demographics, disease characteristics, presentation delay interval, treatment received, and complications in pediatric populations. Despite the lack of evidence for differences in MSK infections attributable to ADI, this does not negate the potential existence of such a relationship.

Pasteurella multocida is known to be the most commonly isolated pathogen of soft tissue infections caused by cat or dog-inflicted wounds. We present a case of a 66-year-old female who was bitten by a cat, prescribed antibiotic therapy outpatient, and developed a septic metacarpophalangeal joint despite appropriate antibiotics. A failure to improve with appropriate antibiotic therapy should raise suspicion of a source control problem and prompt surgical intervention, a principle that is highlighted in this case. Pasteurella multocida septic arthritis of the fingers manifests in less than 4% of cases, making this case a rare presentation of a septic joint, which necessitated surgical management.

UNASSIGNED: Multiple spinal epidual abscesses with multifocal systemic abscess and multiple joint septic arthritis present with a large infective burden resulting in sepsis, systemic inflammatory dysregulation, and multi-organ failure. This requires pre-operative resuscitation and surgery of greater complexity, longer operative duration, and blood loss, creating challenges to surgical management.
UNASSIGNED: A 69-year-old Chinese female presented with multilevel discrete spinal epidural abscesses along the cervical, thoracic, and lumbar spine, alongside concomitant multifocal systemic abscesses and multiple small joint septic arthritis. She received pre-operative resuscitation to restore organ function, reverse acidosis, and coagulopathy, prior tobefore surgical decompression of selected abscesses and joints under a multidisciplinary team. Remaining sites of infection without significant compression were undrained. The patient recovered well with no residual neurological deficits.
UNASSIGNED: Multifocal infections in critically ill patients require a multidisciplinary team for preoperative resuscitation, joint surgical planning, and prioritiszing surgical interventions to prevent excessive surgical stress to the patient.

BACKGROUND: Facet joint septic arthritis (FJSA) is an uncommon cause of neck pain, most frequently occurring in the lumbosacral spine. Cervical facet joint septic arthritis is particularly rare. Symptoms typically include spinal or paraspinal pain and tenderness, with severe infections potentially causing neurological impairments. This condition can progress to discitis and osteomyelitis. High clinical suspicion is required for accurate diagnosis and timely treatment.
OBJECTIVE: To present the first known case of cervical spine FJSA caused by Moraxella species and provide an updated narrative review of cervical spine FJSA.
METHODS: A case study of a 66-year-old male with cervical spine FJSA caused by Moraxella osloensis is detailed. Additionally, a librarian-assisted literature search was conducted on MEDLINE Pubmed, filtering for adult human trials and including various study types, resulting in the inclusion of 9 relevant manuscripts.
RESULTS: The patient\'s symptoms included neck, right upper thoracic, and periscapular pain, with episodes of numbness and tingling. MRI revealed septic arthritis at the C7-T1 facet joint and associated osteomyelitis. Cultures identified Moraxella osloensis as the causative agent. The patient was successfully treated with antibiotics and experienced significant symptom improvement. Literature review highlights that Staphylococcus aureus is the most common causative agent of cervical FJSA, with diagnosis typically involving MRI and culture tests. Treatment generally includes long-term antibiotics, with some cases requiring surgical intervention.
CONCLUSIONS: This report underscores the need for high clinical suspicion in diagnosing FJSA and highlights the importance of early intervention. It documents the first known case of cervical spine FJSA caused by Moraxella osloensis, contributing valuable information to the limited literature on this rare condition.

Gouty stone ulcers inducing bloodstream infections leading to chest wall and mediastinal abscesses and progression to sepsis and hemophagocytic syndrome are extremely rare in clinical practice. Keep in mind the possibility of coexistence of gout and septic arthritis. Prompt and accurate diagnosis and treatment of hemophagocytic syndrome (HPS), a highly fatal disease with acquired immunoregulatory abnormalities and release of large amounts of inflammatory factors, are important to save the patient\'s life.

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Sickle cell disease (SCD) is a hereditary red cell disorder with clinical manifestations secondary to sickling or crescent-shaped distortion of the red blood cells. Musculoskeletal complications of SCD are often the main causes for acute and chronic morbidities in children with manifestations including osteomyelitis, osteoporosis and osteonecrosis. This article aims to familiarise the paediatric radiologist with appendicular skeletal complications of SCD in the paediatric population and their imaging appearance.