Methicillin– resistant Staphylococcus aureus (MRSA) infected gap non –union of long bones fractures is a challenge to manage. Treatment options are limited such a Ilizarov bone transport, vascularized bone free transfer etc. These techniques have complications and require expertise. We present a rare case with MRSA infected nonunion and bone defect 5cm of ulna which was managed with the induced membrane formation. A 33-years old male presented to outpatient department, 2 months after internal fixation on both left bone forearm fractures (Gustillo I). There was pus discharge from the operative site of ulna. Culture results: MRSA, C-Reactive Protein (CRP): 2,58 (0–5), Erythrocyte Sedimentation Rate (ESR): 42 (0–20). Intravenous (iv) Teicoplanin and Rifampicin were administrated and after one month no topic symptoms and CRP- ESR were normal. One month later he had again actively draining sinus (CRP: 1,47 ESR:22). The implant (ulna) was removed and a gap 5 cm was created at the fracture site (necrotic-infected bone debrided), which was filled by cemented spacer (Tobramycin and vancomycin). An external fixator was applied to ulna. Radius was not involved. Post op. iv the same antibiotics for 4 weeks. At the end of 8 weeks, the spacer was removed and the gap was filled with autologous cancellous bone graft (iliac crest). After 5 months the patient was reviewed. No any clinical and functional problems. Radiographics and CT-images were showed osseous consolidation. This technique (called as ‘Masquelet’) gives promising result in the management of infected long bone defects in upper extremity.
Intraarticular osteoid osteomas account for approximately 13% of osteoid osteomas. The hip is the commonest location of intraarticular osteoid osteomas. We present 16 patients with intra-articular osteoid osteomas of the hip treated with RFA. These were 13 men and 3 women, with a mean age of 27 years (range, 16–48 years). Eight osteoid osteomas were located in the femoral head, 6 in the femoral neck, and 2 in the acetabulum. The approximate mean duration of the procedure was 82 min (range, 50–125 min). The mean hospitalization time was 8.7 h (range, 6–12 h). All patients had pain improvement within the first 24 h. Five patients had pain relief within the first 3 days, 9 patients within the first week, and 2 patients within 2 weeks post-procedural. Twelve patients continued to have some restriction of their physical activities up to one month after the operation. All patients returned to their previous status of physical activity within the first 2 to 3 months post-procedural. At the latest follow-up, there were no residual or recurrent symptoms. Five patients complained for mild pain, which was probably due to hip synovitis that resolved within a week. One patient experienced transient paresthesias and pain in the buttock at the site of the trocar and electrode insertion. Intra-articular osteoid osteomas have clinical and imaging features significantly different from those seen in extra-articular lesions. CT-guided percutaneous RFA is a simple minimally invasive, safe and effective method for most intra-articular osteoid osteomas.
