Aim: The neonatal screening procedure in South Australia has shown that the late diagnosis of developmental dysplasia of the hip (DDH) is rare with well conducted clinical screening. We studied the cases of late diagnosis of DDH to determine the epidemiological features and the out come of management with special reference to development of the femoral head and acetabulum. Methods: Patients’ case records and radiographs with a delayed diagnosis of DDH, identified by the South Australian Birth Defects Register between 1988 and 1993, were reviewed. Epidemiological features, acetabular angles, size of femoral head, spherical index, CE angle and migration percentage were examined. The Severin’s grouping and Makey’s criteria were used to assess radiological and clinical outcomes. Late DDH was defined as DDH diagnosed after three months of age. Results: The acetabular angles and percentage coverage improved rapidly -faster in younger children. The CE angle also improved rapidly. When treatment was started late (after one year) the improvement was slower and final out come was unpredictable. The femoral head continued to grow irrespective of age at reduction and became normal in most cases. In some patients Salter osteotomies stabilised the hips after open reductions and gave excellent results. The epidemiological features were compared with that of DDH diagnosed early in postnatal life. Conclusions: Clinical screening and early detection is important in the outcome of DDH. Early treatment may give better results

To assess outcomes following a radical approach to cases of compartment syndrome in which a significant degree of muscle necrosis is found, 4 paediatric and adolescent patients with a delayed diagnosis of compartment syndrome in which muscle necrosis in single or multiple compartments were treated by radical debridement of necrotic tissue and reconstruction of the anterior compartment through transfer of peroneus brevis to extensor digitorum and hallucis longus tendons. Where suitable, a free vascularised and innervated gracilis muscle transfer to the tibialis anterior tendon stump was carried out with anastomosis of the nerve to gracilis to the deep peroneal nerve. Free gracilis muscle transfer was functional in one of the two patients whilst peroneus brevis transfer to extensor digitorum and hallucis tendons was functional in all three patients. In one patient, radical debridement resulted in loss of the entire anterior compartment requiring permanent ankle foot orthosis. All others had recovery of protective foot sensation and at minimum follow-up of 12 months were walking unaided. Infection was not seen in any patient. Prompt fasciotomy, debridement and reconstruction for late diagnosis of compartment syndrome proved limb-saving in our patients

Aims. Developmental dysplasia of the hip (DDH) can be managed effectively with non-surgical interventions when diagnosed early. However, the likelihood of surgical intervention increases with a late presentation. Therefore, an effective screening programme is essential to prevent late diagnosis and reduce surgical morbidity in the population. Methods. We conducted a systematic review and meta-analysis of the epidemiological literature from the last 25 years in the UK. Articles were selected from databases searches using MEDLINE, EMBASE, OVID, and Cochrane; 13 papers met the inclusion criteria. Results. The incidence of DDH within the UK over the last 25 years is 7.3/1,000 live births with females making up 86% of the DDH population (odds ratio 6.14 (95% confidence interval 3.3 to 11.5); p < 0.001). The incidence of DDH significantly increased following the change in the Newborn and Infant Physical Examination (NIPE) guidance from 6.5/1,000 to 9.4/1,000 live births (p < 0.001). The rate of late presentation also increased following the changes to the NIPE guidance, rising from 0.7/1,000 to 1.2/1,000 live births (p < 0.001). However, despite this increase in late-presenting cases, there was no change in the rates of surgical intervention (0.8/1,000 live births; p = 0.940). Conclusion. The literature demonstrates that the implementation of a selective screening programme increased the incidence of DDH diagnosis in the UK while subsequently increasing the rates of late presentation and failing in its goal of reducing the rates of surgical intervention for DDH. Cite this article: Bone Jt Open 2023;4(8):635–642

Congenital Dislocation of the Hip (CDH) has been routinely screened for at birth using clinical tests since the early 60’s. In Edinburgh Macnicol (. 1. ) assessed the screening programme between 1962 to 1986. It particularly focussed on the change in incidence of late diagnosis when screening was undertaken by experienced staff in comparison to junior staff. The treatment of Orthopaedic conditions in children within the Edinburgh area was combined at the Royal Hospital for Sick Children in 1995. Therefore this paper aims to reassess the screening programme for CDH between 1995–1999 and compare it with the previously achieved results in the same population. From 1 Jan 1995 to 31 Dec 1999 there were 34,597 live births at Edinburgh’s Maternity hospitals. An orthopaedic clinical assistant examined all infants within the first 24 hours with considerable experience in this field. In addition to the Ortolani and Barlow tests, skeletal and skin fold asymmetry, limitation of abduction and loss of the physiological flexion deformity present in the normal neonate were observed. FH, delivery and circumstances of the pregnancy were noted. Hips found to be clinically unstable were referred on to the CDH clinic where further assessment and ultrasound were performed in order to decide upon the further management of each child. In 1995 there were 7179 live births, 2.93 of which were harnessed (incidence per 1000 births), 1.11 late diagnosis, (incidence per 1000 births) and 1.39 were operated upon (incidence per 1000 births). In 1996 there were 7144 live births, 3.64 of which were harnessed (incidence per 1000 births), 1.40 late diagnosis, (incidence per 1000 births) and 1.82 were operated upon (incidence per 1000 births). In 1997 there were 7065 live births, 2.12 of which were harnessed (incidence per 1000 births), 0.57 late diagnosis, (incidence per 1000 births) and 0.71 were operated upon (incidence per 1000 births). In 1998 there were 6763 live births, 4.14 of which were harnessed (incidence per 1000 births), 0.59 late diagnosis, (incidence per 1000 births) and 0.30 were operated upon (incidence per 1000 births). In 1999 there were 6446 live births, 6.12 of which were harnessed (incidence per 1000 births), 0.78 late diagnosis, (incidence per 1000 births) and 0.62 were operated upon (incidence per 1000 births). Overall there were 34597 live births, 3.76 of which were harnessed (incidence pre 1000 births), 0.89 late diagnosis, (incidence per 1000 births) and 0.98 were operated upon (incidence per 1000 births). The incidence of late diagnosis of CDH in Midlothian has increased from 0.5 per 1000 as reported by Macnicol between 1962–1986 to 0.89 per 1000 over the last 5 years. These results are clearly disappointing. Although Catford et al (. 2. ) has proposed that the incidence of CDH has been increasing this does not explain the size of the increase in late diagnosis seen. Further investigation is required in order to reduce this late presentation rate to that previously achieved

Introduction. In this study we decided to observe the incidence of osteoarthritis following ORIF of Lisfranc joint injury. We also intended to point out the influence of different factors such as late diagnosis of the fracture, co-fractures, and open or close fractures on the incidence of osteoarthritis. Methods. Patients with a dislocation more than 2 millimeters in simple AP, lateral and oblique radiograms of the foot who went through ORIF were included. Patients were classified according to: Anatomic or non-anatomic reduction, open or close fractures, presence of other fractures and early or late diagnosis (up to 6 weeks). The incidence of osteoarthritis was then compared in these groups. Results. In 20 patients (45%), post traumatic osteoarthritis occurred. In the 10 patients with non-anatomic reduction, 8 (80%) experienced osteoarthritis, when from the 34 patients with anatomic reduction 12(35%) did so (p = 0.004). Discussion. 9% of the cases were not diagnosed in the 1st visit and 22% attended the hospital with delay. According to the findings, having either open or close fracture or delayed diagnosis up to 6 weeks has no influence on the prevalence of osteoarthritis after trauma, and the only important factor affecting the prevalence of post-traumatic osteoarthritis is anatomic reduction

Aim. The aim of this study is to assess the effectiveness of clinic based ultrasound screening by Orthopaedic surgeon for early diagnosis and treatment of developmental dysplasia of hip (DDH) in one stop clinic. Methods. This prospective study included 395 infants (185 male and 210 female) (5.2% of study population) who were referred for screening on the basis of abnormal findings or the presence of risk factors for DDH. Average age was 12.5 weeks (1 day to 15 months). All infants were assessed for risk factors of DDH. Clinical examinations were performed by the senior author followed by ultrasonography of both of the infant's hips, using the Graf's technique. Alpha and beta angles were calculated and hips were classified according to Graf's classification system. Results. Out of 790 hips examined 670 (84.8%) were labelled as normal. 120 (15.1%) hips in 84 patients were diagnosed as dysplastic or dislocated. Clinical examination only detected 39 patients out of 84, sensitivity of 46%. Average age of diagnosis was 12 weeks (3days-11 months). 79 patients were successfully treated with pavlic harness, 2 required traction and 3 were referred for surgical treatment. There were 14 cases of late diagnosis during one year period (> 4 months of age) (1.8/1000). Conclusion. Selective ultrasound screening is effective in early diagnosis of DDH and significantly reduces the duration of non operative treatment as well as the need for surgical intervention but does not completely eliminate late diagnosis of DDH. We find the concept of one stop DDH clinic highly effective and recommend that ultrasound training should be a part of orthopaedic curriculum

The incidence of DDH Varies depending on genetic and ethnic varieties but in Ireland on an average in 3 per 1,000 live births. Current treatment is focused on early diagnosis and congruent reduction of the hip joint. With conservative measures, principally skilful use of the Pavlik harness, the majority of (85%) of dislocated or subluxated hips will be successfully treated. Late diagnosis impacts on the mode of treatment and on the subsequent outcome. An audit of annual incidence of DDH in North Eastern health board, in Ireland showed a dramatic increase in late diagnosis (> 4 month). There were 4668 live births in 2004 with 17 cases of DDH presenting between the ages of 4 – 36 months during this period. The mean age of presentation was 10 months. Two cases were bilateral. The male: female ratio was 4.6:1. Risk factor analysis showed, only 50% fell in to the high risk group, majority of them had positive family history. Three fourth of them were frank dislocations and all of them required operative intervention. As opposed to early presenters, only 10% needed operative intervention. 30% of the late presenters needed major osteotomies. We examined the reasons for this extreme high rate of late presenters and argue for the introduction of routine ultrasound screening in this region based on historical high incidence of DDH and the dramatic incidence of delayed diagnosis

Aims

Posterior malleolar (PM) fractures are commonly associated with ankle fractures, pilon fractures, and to a lesser extent tibial shaft fractures. The tibialis posterior (TP) tendon entrapment is a rare complication associated with PM fractures. If undiagnosed, TP entrapment is associated with complications, ranging from reduced range of ankle movement to instability and pes planus deformities, which require further surgeries including radical treatments such as arthrodesis.

The aim was to compare the efficacy of selective ultrasound-screening (SUSS) for developmental dysplasia of the hip (DDH) to clinical screening alone, by comparing outcomes in a contemporary group with those from a 40 year old cohort. This was a retrospective cohort study. The department's DDH and surgical databases were used to identify all cases of DDH, and all cases of surgery for DDH during the study period (2009–13). Patients born outside our region, and teratologic cases were excluded from analysis. The Obstetric database provided the total number of live births over the five-year period. This data was used to calculate the incidence of late-diagnosis (age over 3 months) DDH and the rate of surgery for DDH in our region. These results were compared to those of a similar study from our institution published in 1977, after the introduction of universal clinical screening. Relative risk (RR) was calculated for the two groups, and analysed for statistical significance. The incidence of late-diagnosis DDH over the recent 5-year study period was 0.66/1000 live births, compared to 0.6/1000 in the control group. The RR for late-diagnosis DDH was not significantly different between the two groups (RR 1.14, 95% CI 0.6 to 2.2). The rate of surgery for DDH was 0.86/1000, compared to 0.9/1000 live births in the control group. The RR for surgery for DDH in the current study population compared to the historic control was 0.97, but this difference was not statistically significant (95% C.I. 0.57 to 1.68; p=0.92). Despite advances in screening for DDH over the last 40 years, neither the incidence of late diagnosis DDH, nor rates of surgery for DDH in our region have changed. Whilst previous studies have demonstrated that SUSS does not eliminate late-presenting DDH, this study suggests it confers no advantage over clinical screening alone

Aims

Developmental dysplasia of the hip (DDH) describes a pathological relationship between the femoral head and acetabulum. Periacetabular osteotomy (PAO) may be used to treat this condition. The aim of this study was to evaluate the results of PAO in adolescents and adults with persistent DDH.

Pyogenic sacroiliitis (PS) is one of the less frequent localizations among joint infections, near the 1,5%. A late diagnosis generally exists. So we decided to analyze its behaviour in our uniit. A retrospective study of 39 records was carried out, 32 with diagnosis of entrance of PS and 7 with another pathology's diagnosis that turned out to be a PS, among the years 1999 and 2014 in our unit. 27 only fulfilled the requirements to be classified as PS (Clinic features of infection and sacroiliac localization, laboratory exams and Tc-99 bone scintigraphy alterations). 20 males and 7 females (74% males), 52% right sacroiliac joint, only 7 had clinically predisposing conditions (trauma), aged between 3 and 14 years (average 9.6 years). The half time of clinical evolution foresaw to diagnosis was of 4,7 days (6,7 days between 1999–2005 and 3,5 between 2006–2014) (range between 1 and 10 days). The main symptom that motivates the consultation was fever (96%) accompanied by FABER test positive (70%) by buttock pain (52%) and by limping (48%). Laboratory exams: WBC count was normal in 11 cases and elevated in 16 cases too and only in 5 cases with left deviation (PMNs elevated); CRP higher than 55 mg/dl in 23 patients (100% over 20mg/dl), ERS with value average of 72 mmHg/hour (27–111). Blood cultures were positive in 70% and the Staphylococcus aureus was the main bacteria founded (89%). No radiological alterations were found initially. The TC-99 bone scintigraphy was positive in all cases after the third day. All patients had a 5 to 12 days course of intravenous antibiotics (oxacillin + amikacin in 96% of patients) and then completed 4 weeks with oral oxacillin. All patients recovered without sequel. Blood cultures may be obtained prior the antibiotics’ administration. The Staphylococcus aureus is by far the most frequent germ involved in this process, and it may guide the empiric antibiotic therapy. The precocious antibiotic treatment solves the case without sequels. The PS is an uncommon pathology in children that makes it often not recognized initially. Wrong diagnosis such as appendicitis, transient synovitis of the hip, discitis, etc. can be avoided if PS is sought in a systematic way

Soft tissue tumours on the sole of the foot are rare and difficult to diagnose, we report a series of five patients who presented with a late diagnosis of a soft tissue tumour on the soles of their feet. We reviewed the notes of five patients who presented with lesions on the soles of their feet. There were 3 males and two females with an age range from 35yrs to 78 yrs. Our results showed that there was at least a one year delay in their diagnosis from their initial symptoms. They all sought medical treatment late, and were all originally diagnosed with benign lesions at their first presentation. All but one, were found to have malignant lesions on biopsy which required surgical excision. As a consequence of the delay in their presentation and diagnosis, there was also a delay in their treatment. Our conclusions are that tumours on the soles of the feet are difficult to diagnose and almost invariably present late

Synovial Sarcoma of the foot is the most common soft tissue sarcoma to present in the foot. Despite this, diagnosis is often delayed and treatment may be difficult. The aim of this paper is to review the presenting features, management and outcome of synovial sarcoma of the foot and to try and identify areas for improvement. 33 patients with synovial sarcoma were treated at out unit over a 25 year period. The average duration of symptoms was 125 weeks. The age range at presentation was 11 to 80 years (mean 44). The mean size of the tumour at diagnosis was 5cm in diameter (range 1–10cm). 75% of the tumours were deep at the time of diagnosis. Treatment was by amputation in 21 patients and limb salvage in 11 with 1 patient receiving palliative chemotherapy. Only one patient had local recurrence and presented with lung metastases. Four patients had metastases at diagnosis and nine developed them subsequently. Overall survival at 10 years was 53%. These results have shown that late diagnosis is common for synovial sarcoma of the foot and that by the time of diagnosis 75 % have invaded extra-compartmentally leading to a high risk for amputation. 20 patients had an inadvertent excision of the tumour before referral to our unit. Local control was best achieved with amputation. Overall survival was surprisingly poor despite successful local control. Earlier aggressive investigation of patients with foot pain or swelling but no other features may change their long term prognosis

Introduction: Soft tissue tumours are common in the foot however few are malignant. Synovial Sarcoma of the foot is the most common soft tissue sarcoma to present in the foot (~50%). Despite this diagnosis is often delayed and treatment may be difficult. The aim of this paper is to review the presenting features, management and outcome of synovial sarcoma of the foot and to try and identify areas for improvement. Method: The clinical presentation, radiological features and treatment of 33 patients with histologically proven synovial sarcoma of the foot were reviewed along with outcomes in terms of local control, metastases and survival. Results: 33 patients with synovial sarcoma were treated at out unit over a 25 year period, 22 in the last 10 years. The average duration of symptoms was 125 weeks. The age range at presentation was between 11 to 80 years (mean 44). The mean size of the tumour at diagnosis was 5cm in diameter (range 1–10cm). 75% of the tumours were deep at the time of diagnosis. Treatment was by amputation in 21 patients and limb salvage in 11 with 1 patient receiving palliative chemotherapy. Only one patient had local recurrence and presented with lung metastases. Four patients had metastases at diagnosis and nine developed them subsequently. Overall survival at 10 years was 53%. Discussion: These results have shown that late diagnosis is common for synovial sarcoma of the foot and that by the time of diagnosis 75 % have invaded extra-compartmentally leading to a high risk for amputation. 20 patients had an inadvertent excision of the tumour before referral to our unit. Local control was best achieved with amputation. Overall survival was surprisingly poor despite successful local control. Conclusion: Earlier aggressive investigation of patients with foot swelling or pain may influence their long term prognosis

Introduction: Despite early screening, infants continue to present late ( > 4 months) with DDH. The impact of late diagnosis is significant. Established DDH causes significant morbidity and may have major medicolegal implications. Aim: To review the incidence of late presenting DDH nationally for a single year and assess the patterns of referral. To identify the reasons for the late presentation of DDH in the presence of early clinical screening. Methods: In a retrospective study all cases of late DDH presenting in 2004 were identified using inpatient database. Patient records were retrieved and data collected. Results: Fifty nine cases of DDH were diagnosed at greater than 4 months. There was an additional 26 cases of isolated acetabular dysplasia treated at greater than four months. The mean age of diagnosis was 14.6 months (range 4–72). Many of the late referrals had risk factors for DDH. Conclusion: Despite routine clinical screening at birth and six weeks, children continue to present with late DDH. This represents a significant workload for our tertiary unit

Universal neonatal screening of developmental dysplasia of the hip (DDH) remains controversial and a few centres have adapted this practice in the United Kingdom. Our institute has established a DDH screening programme over the last 19 years. The following shows our result after a recent change in our screening programme protocol. All infants born in Coventry are screened for DDH by a clinical examination and ultrasound scan (USS). 5,084 babies were born over a 12-months period. Normal examination and USS were detected in over 90% of the cases. Abnormality detected through either clinical examination or USS was referred to a special orthopaedic/USS clinic. However, in the majority of the cases, subsequent assessments were normal and only 23 babies required treatment. In these cases, the majority had not shown any signs of clinical abnormality. However, serial USS had shown persistent abnormality of at least Graf grade II or higher. The average time from birth to a treatment with a Pavlik Harness was 35 days and the average duration of a treatment was 48 days. Apart from one case, all the babies were treated successfully. The unsuccessful cases had a Graf grade IV at the presentation and had shown no sign of improvement on sequential USS. No complications were noted. While the sensitivity of detecting DDH through clinical examination remains poor, USS has become an essential tool in our screening programme. Many initial abnormalities are secondary to hip immaturity and they tend to resolve. Those with clinical instability and persistent USS Graf grade II or higher should be treated with early Pavlik Harness. Early detection has led to better results than late diagnosis, and in addition to this, the overall number of operations required could be reduced. Yet, the need for a major surgical intervention has been all but eliminated

Universal neonatal screening of developmental dysplasia of the hip (DDH) remains controversial and a few centres have adapted this practice in the United Kingdom. Our institute has established a DDH screening programme for many years. The following shows our result after a recent hospital relocation and changes to the screening programme. All infants born in Coventry are screened for DDH by a clinical examination and ultrasound scan (USS). 5,084 babies were born over a 12-months period. Normal examination and USS were detected in over 90% of the cases. Abnormality detected through either clinical examination or USS was referred to a special orthopaedic/USS clinic. However, in the majority of the cases, subsequent assessments were normal and only 23 babies required treatments. In these cases, the majority had not shown any signs of clinical abnormality. However, serial USS had shown persistent abnormality of at least Graf grade II or higher. The average time from birth to a treatment with a Pavlik Harness was 35 days and the average duration of a treatment was 48 days. Those with Graf III or higher at initial presentation, but spontaneous reduced without treatment were follow-up to one year. The acetabular index in these cases was normal. Apart from one case, all the babies were treated successfully. The unsuccessful cases had a Graf grade IV at the presentation and had shown no sign of improvement on sequential USS. While the sensitivity of detecting DDH through clinical examination remains poor, USS has become an essential tool in our screening programme. Many initial abnormalities are secondary to hip immaturity and they tend to resolve. Those with clinical instability and persistent USS Graf grade II or higher should be treated with early Pavlik Harness. Early detection has led to better results than late diagnosis, and in addition to this, the overall number of operations required could be reduced

Purpose of study: To report the use of a forearm fascial strip to repair the annular ligament and treat late diagnosed or irreducible Monteggia fracture. Methods: Through Boyd’s approach nineteen patients with Monteggia fractures were treated with a technique to reconstruct the annular ligament using forearm fascia, retaining its proximal attachment to the ulna. The radial head was dislocated and the fascial strip wound around the neck of the radius. After reducing the radial head, forearm rotation was checked. The strip was sutured to the residual annular ligament on the proximal ulna after correction of any ulna deformity. In late diagnosis, the ulna deformity was managed with ulna lengthening of approximately 0.5 cm and stabilization with a 4- or 5- hole semi-tubular AO plate. The stability of the radial head was then assessed using intra-operative fluoroscopy. Results: Stability of the radial head was achieved in all cases. According to the Anderson classification, the final outcome was excellent in ten cases satisfactory in eight cases and unsatisfactory in one late diagnosed patient with an associated radioulnar synostosis secondary to a compartment syndrome. There were no failures. Two radiocapitellar K-wires broke while in plaster in the initial period, so the use of a K wire was subsequently abandoned. Conclusions: We have found this technique to be reliable for stabilizing the proximal radioulnar joint. The length of the incision is less than that required for the Bell Tawse (triceps tendon) technique and permits a tourniquet on the upper arm. Poorer results were achieved with delay in diagnosis beyond 6 months. Patients must be warned of potential reduction of forearm rotation

Aims: Although the septic arthritis in children and adolescents is rarely the purulent coxitis occurs more often than in other joints. There is a high risk of destruction of the cartilage due to late diagnosis or inadaequate therapy. The arthroscopy of the hip joint gains in importance even in children. Methods: From 6/96 until 1/2001 we treated 14 children (4 month to 14 years old) with coxitis by arthroscopy of the hip joint. The follow up includes clinical outcome and results of blood tests (CRP and leucozytes). Results: All children represented clinical signs of an infection and showed increased infection parameters. There was seen an intraarticular effusion by ultrasound examination. We did arthoscopic debridement 1–2 times in all patients followed by an antibiotic treatment. The early mobilisation with fully weight bearing was allowed dependent on complaints. There was a painfree mobility, free range of motion and normal blood tests after 3–4 weeks in all patients. No complication, respectively no lesions of nerves and vessels and no iatrogen infection were seen. Conclusions: If the indication for arthroscopic treatment is correct, the arthroscopic lavage in septic coxitis shows a shorter time of immobilisation, a lower complication rate and a less morbidity in comparison to open revision of the joint. It is a low risk operation and less traumatic for children and parents

Most of the studies in the literature identify spondylodiscitis as a challenge for the physician: symptoms are not specific and sub-acute/chronic presentation is common. The question of when surgery is indicated is a frequent matter of debate. We want to present and validate our flow chart for spinal infections diagnosis and treatment. A retrospective review of 128 cases of spinal infections presenting over a 10-year period was performed. Medical records, imaging (X-Rays, MRI with gadolinium, Ga-67 and Tc-99 bone scan), laboratory test and bacteriology results of 128 patients from 1997 to 2006 were reviewed. The average age of presentation was 55 years (median age: 61 years, range: between 1 and 88 years) of 53 females and 75 males. Only one level was interested in 22% of the cases. The cervical spine was affected in 6% of cases, the thoracic spine in 37%, and the lumbosacral spine in 57%. Soft tissues have been affected in 16% of the patients. CT guided trocar biopsies were performed in 80 patients, incisional biopsies in 10 patients, and excisional biopsy in 1 case. No complication occurred. The most represented microorganisms which were identified were Staphylococcus Aureus and Mycobacterium Tuberculosis. Conservative treatment alone (antibiotic therapy and bracing) was performed in 84 cases out of 128 (66%); Forty-four patients with either neurologic compromise or mechanical instability or those who were unresponsive to drugs and immobilisation were submitted to surgical treatment. Late diagnosis may lead to spinal deformities, prolonged hospital stay and more expensive management of the patient. Appropriate treatment usually brings to resolution even if spinal infections are rare and often misdiagnosed. We suggest an easy-to-follow flow-chart for the diagnosis and treatment of spinal infections