Obturator internus pyomyositis: iatrogenic haematogenous spread.

Obturator internus pyomyositis is a rare disorder that should be on the differential diagnosis in a child who presents with a fever, limp, abdominal or groin pain. We present a case of a 5-year-old girl successfully treated with open drainage following failed medical management. We postulate the source of infection to be secondary to an infected elastic stable intramedullary nail in the forearm that was protruding through the skin.

Marginal excision and Ilizarov hemicallotasis for osteofibrous dysplasia of the tibia: a case report.

The surgical management of osteofibrous dysplasia (OFD), a rare developmental tumour-like condition of childhood that has a predilection for the tibia, ranges from curettage or subperiosteal resection to extraperiosteal wide resection followed by reconstruction. En-bloc excision followed by distraction osteogenesis has been described earlier for OFD. We describe a novel technique in which marginal excision was performed but instead of excising an entire segment of tibia, only the anterior portion containing the lesion was excised, sparing the uninvolved posterior cortex. Distraction osteogenesis was carried out on the anterior portion of the tibia (hemicallotasis) after acute correction of the deformity. Although the potential advantage is a decrease in time required for consolidation of the bone regenerate, this technique is dependent on the anatomical characteristics of the lesion. We describe a case in which this technique was adopted on a child with tibial OFD with resultant disease-free excision margins and deformity correction.

Proximal Tibial Sleeve Fracture: Case Report of a Rare Injury and Review of the Literature.

A sleeve fracture occurs when a ''sleeve'' of cartilage or periosteum is avulsed with or without an osseous fragment, an injury most commonly reported in the patella. Proximal tibial sleeve fractures are extremely rare and we present a case in an adolescent male who had concomitant osteochondral as well as chondral fractures of his patella. Sleeve fractures present in the skeletally immature, and may look relatively benign on radiographs, but misdiagnosis may lead to adverse consequences. Clinicians should have a high index of suspicion if a child or adolescent presents with a knee injury with clinical concerns regarding the extensor mechanism. Given that the ''sleeve'' of the injury contains tissue with osteogenic potential, we recommend that displaced proximal tibial sleeve fractures should be managed operatively to avoid dysfunction of the extensor mechanism. These patients should also have perioperative assessment for occult osteochondral and chondral injuries that are potentially repairable and thus may have implications for prognosis.