Scedosporium prolificans osteomyelitis in an immunocompetent child treated with a novel agent, hexadecylphospocholine (miltefosine), in combination with terbinafine and voriconazole: a case report.

We describe an 8-year-old girl who sustained multiple compound fractures in an accident involving agricultural equipment. She developed Scedosporium prolificans osteomyelitis of the pelvis, septic arthritis of the hip, and myositis of adjacent muscles. The infection progressed, despite extensive surgical debridement and joint washouts with 0.2% polyhexamethylene biguanide; antifungal therapy with caspofungin, terbinafine, and voriconazole; and adjunctive therapy with interferon-gamma. Gradual resolution was achieved after the addition of a novel agent, hexadecylphospocholine (miltefosine), and the continuation of terbinafine and voriconazole. This is the first report of the use of miltefosine as an antifungal agent in the management of severe infection with S. prolificans.

Can the material properties of regenerate bone be predicted with non-invasive methods of assessment? Exploring the correlation between dual X-ray absorptiometry and compression testing to failure in an animal model of distraction osteogenesis.

Evaluation of the material properties of regenerate bone is of fundamental importance to a successful outcome following distraction osteogenesis using an external fixator. Plain radiographs are in widespread use for assessment of alignment and the distraction gap but are unable to detect bone formation in the early stages of distraction osteogenesis and do not quantify accurately the structural properties of the regenerate. Dual X-ray absorptiometry (DXA) is a widely available non-invasive imaging modality that, unlike X-ray, can be used to measure bone mineral content (BMC) and density quantitatively. In order to be useful as a clinical investigation; however, the structural two-dimensional geometry and density distributions assessed by DXA should reflect material properties such as modulus and also predict the structural mechanical properties of the regenerate bone formed. We explored the hypothesis that there is a relationship between DXA assessment of regenerate bone and structural mechanical properties in an animal model of distraction osteogenesis. Distraction osteogenesis was carried out on the tibial diaphysis of 41 male, 12 week old, New Zealand white rabbits as part of a larger study. Distraction started after a latent period of 24 h at a rate of 0.375 mm every 12 h and continued for 10-days, achieving average lengthening of 7.1 mm. Following an 18-day period of consolidation, the regenerate bone was subject to bone density measurements using a total body dual-energy X-ray densitometer. This produced measurement of BMC, bone mineral density (BMD) and volumetric bone mineral density (vBMD). The tibiae were then disarticulated and cleaned of soft tissue before loading in compression to failure using an Instron mechanical testing machine (Instron Corporation, Massachusetts USA). Using Spearman rank correlation and linear regression, there was a significant correlation between vBMD and the Modulus of Elasticity, Yield Stress and Failure Stress of the bone. No correlation was seen between BMC, BMD, vBMR and any mechanical parameter. DXA is a promising tool for the assessment of regenerate bone formed by DO during limb lengthening and requires further investigation.

Unilateral limb deformity due to fibrous tethers: a report of three cases.

Fibrous tethers are a rare cause of unilateral limb deformity. A review of the literature revealed 9 cases previously described, all located in the distal femur. We report 3 additional cases of fibrous tethers, 2 of which were located in anatomical areas not previously described. The fibrous tethers were excised in all cases, and an osteotomy was performed in 2 of the cases. The clinical, radiological, and histopathologic findings are discussed for each case.