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Chronic Recurrent Multifocal Osteomyelitis with Non-Contiguous Involvement of the Spine: A Case Report and Review of Literature

DOI- https://doi.org/10.13107/ijpo.2026.v12.i01.258

Open Access License: CC BY-NC 4.0

Submitted: 30/09/2025; Reviewed: 21/10/2025; Accepted: 09/12/2025; Published: 10/02/2026

Authors: S Kailash MS Ortho [1], Vijaysriram MS Ortho [1]

[1] Department of Paediatric Orthopaedics, Kanchi Kamakoti Child trust Hospital, Chennai, Tamil Nadu, India.

Address of Correspondence

Dr. S.Kailash,
Senior Consultant, Department of Paediatric Orthopaedics, Kanchi Kamakoti Child trust Hospital, Chennai, Tamil Nadu, India.
E-mail: kailasdoc2989@gmail.com

Abstract

Background: Chronic Recurrent Multifocal Osteomyelitis (CRMO) is a chronic non-bacterial osteomyelitis that affects children and adolescents.
Case Presentation: A 9-year-old previously healthy boy initially presented with vague abdominal pain, for which he was investigated but no active intervention was undertaken. There was increasing pain and deformity over the back noted a week later.
CT thorax was performed to identify the lesion in the rib and an open biopsy was done (resection of diseased rib and transverse process). Biopsy report was suggestive of chronic non-infective osteomyelitis (CRMO). A whole-body magnetic resonance imaging (MRI) showed an additional lesion in the right acetabulum. There was significant relief of symptoms with oral naproxen and intravenous Zoledronate.
At 15 years of age, there was no pain or deformity in the spine and vertebral lesion had reconstituted. The patient was asymptomatic.
Conclusion: CRMO is an under-diagnosed condition. A delay in the diagnosis can result in morbidity in the form of prolonged antibiotic therapy and multiple invasive investigations (biopsy). In most cases, it is a diagnosis of exclusion. This case of a boy with CRMO with main involvement of the spine is presented for its rarity.
Keywords: CRMO, Spine, Zolendronate, Osteomyelitis.

References

1. Yamashita K, Calderaro C, Labianca L, Gajaseni P, Weinstein SL. Chronic recurrent multifocal osteomyelitis (CRMO) involving spine: A case report and literature review. J Orthop Sci 2021;26:300-5.
2. Acikgoz G, Averill LW. Chronic recurrent multifocal osteomyelitis: typical patterns of bone involvement in whole-body bone scintigraphy. Nucl Med Commun. 2014;35:797–807.
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7. Huber AM, Lam PY, Duffy CM, Yeung RS, Ditchfield M, Laxer D, et al. Chronic recurrent multifocal osteomyelitis: Clinical outcomes after more than five years of follow-up. J Pediatr 2002;141:198‐203.
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10. Falip C, Alison M, Boutry N, Job-Deslandre C, Cotten A, Azoulay R, et al. Chronic recurrent multifocal osteomyelitis (CRMO): A longitudinal case series review. Pediatr Radiol 2013;43:355‐75.
11. Hospach T, Langendoerfer M, von Kalle T, Maier J, Dannecker GE. Spinal involvement in chronic recurrent multifocal osteomyelitis (CRMO) in childhood and effect of pamidronate. Eur J Pediatr 2010;169:1105‐11.
12. Batheja D, Munigangaiah S, Jayanna HH, Ghodke A. Contiguous Three- Level Vertebral Collapse in Thoracic Spine: A Novel Presentation of Chronic Recurrent Multifocal Osteomyelitis in 12 years old and Review of Literature. Journal of Orthopaedic Case Reports 2021 June;11(6): 57-62.
13. Sułko J, Ebisz M, Bień S, Błażkiewicz M, Jurczyk M, Namyślak M. Treatment of chronic recurrent multifocal osteomyelitis with bisphosphonates in children. Joint Bone Spine 2019;86:783‐8.
14. Kostik MM, Kopchak OL, Chikova IA, Isupova EA, Mushkin AY. Comparison of different treatment approaches of pediatric chronic non-bacterial osteomyelitis. Rheumatol Int. (2019) 39(1):89–96.
15. Zhao Y, Wu EY, Oliver MS, Cooper AM, Basiaga ML, Vora SS, et al. Consensus treatment plans for chronic nonbacterial osteomyelitis refractory to nonsteroidal antiinflammatory drugs and/or with active spinal lesions. Arthritis Care Res. (2018) 70(8):1228–37.

How to Cite this Article: Kailash S, Vijaysriram. Chronic Recurrent Multifocal Osteomyelitis with Non-Contiguous Involvement of the Spine: A Case Report and Review of Literature. International Journal of Paediatric Orthopaedics. January-April 2026; 12(1): 12-15.

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Pyomyositis of Iliacus in an Adolescent: A Case Report

DOI- https://doi.org/10.13107/ijpo.2026.v12.i01.256

Open Access License: CC BY-NC 4.0

Submitted: 17/10/2025; Reviewed: 06/11/2025; Accepted: 08/01/2026; Published: 10/02/2026

Authors: Kushagra Vashisht MS Ortho [1], Sudhir Rana MS Ortho [1], Parmanand Gupta MS Ortho [1]

[1] Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India

Address of Correspondence

Dr. Parmanand Gupta,
Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India
E-mail: drpgupta123@gmail.com

Abstract

Pyomyositis of the iliacus muscle is rare in children and adolescents. It has an overlapping presentation with septic arthritis of the hip or spondylodiscitis. A 15-year-old boy presented with progressive left hip pain, fever, and limp. T2 weighted MRI images revealed hyperintensities in the iliacus and piriformis muscles. Open surgical drainage was performed with postoperative antibiotics. Hip arthrotomy was not carried out. Complete healing with resolution of symptoms occurred at 2 weeks. This case highlights the importance of prompt imaging and surgical intervention in managing rare musculoskeletal infections, as well as the need for clinicians to maintain a high suspicion for pyomyositis adjacent to the hip joint and avoid unnecessary arthrotomy.
Keywords: Pyomyositis, Iliacus, Hip, Case report

References

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3. Zvulunov A, Gal N, Segev Z. Acute hematogenous osteomyelitis of the pelvis in childhood: Diagnostic clues and pitfalls. Pediatr Emerg Care. 2003 Feb;19(1):29-31
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8. An etiologic shift in infantile osteomyelitis: The emergence of the group B streptococcusEdwards, Morven S. et al. The Journal of Pediatrics, Volume 93, Issue 4, 578 – 583\
9. Nicole I. Montgomery, Howard R. Epps, Pediatric Septic Arthritis, Orthopedic Clinics of North America,Volume 48, Issue 2,2017,Pages 209-216
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11. Kim EY, Kwack KS, Cho JH, et al. Usefulness of dynamic contrast enhanced MRI in differentiating between septic arthritis and transient synovitis in the hip joint. AJR Am J Roentgenol. 2012; 198:428–433.
12. Kirkhus E, Flato B, Riise O, et al. Differences in MRI findings between subgroups of recent-onset childhood arthritis. PediatrRadiol. 2011;41:432–440.
13. Mazur JM, Ross G, Cummings J, et al. Usefulness of magnetic resonance imaging for the diagnosis of acute musculoskeletal infections in children. J Pediatr Orthop. 1995;15:144–147.
14. Key role of magnetic resonance imaging in the diagnosis of infections around the hip and pelvic girdle mimicking septic arthritis of the hip in children. J Pediatr Orthop B. 2016 May;25(3):234-40.
15. Montgomery CO, Siegel E, Blasier RD, et al. Concurrent septic arthritis and osteomyelitis in children. J Pediatr Orthop. 2013;33: 464–467.

How to Cite this Article: Vashisht K, Rana S, Gupta P. Pyomyositis of Iliacus in an Adolescent: A Case Report. International Journal of Paediatric Orthopaedics. January-April 2026; 12(1): 08-11.

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Atypical Clubfoot- A Systematic Review

DOI- https://doi.org/10.13107/ijpo.2026.v12.i01.254

Open Access License: CC BY-NC 4.0

Submitted: 20/11/2025; Reviewed: 13/01/2026; Accepted: 02/02/2025; Published: 10/02/2026

Authors: Shabir A Dhar MS Ortho [1], Tahir Ahmed Dar MS Ortho [1], Reyaz Ahmed Dar MS Ortho [1], Abhishek Raina MS Ortho [1], Mohd Alam MS Ortho [1], Sabqat Farooq MS Ortho [1], Abdul Maajid MS Ortho [1]

[1] Department of Orthopaedics, SKIMS Medical College, Bemina, Srinagar, Kashmir, India.

Address of Correspondence

Dr. Shabir A Dhar,
Department of Orthopaedics, SKIMS Medical College, Bemina, Srinagar, Kashmir, India.
E-mail: shabirdhar@yahoo.co.in

Abstract

Background: The management of congenital talipes equinovarus (clubfoot) has been transformed by the Ponseti technique. However, 5-7% of clubfeet present as atypical or complex variants that are resistant to standard treatment protocols. These challenging cases require early recognition and modified management strategies.
Purpose: To systematically review the literature on atypical/complex clubfoot, defining its clinical characteristics, pathogenesis, and evidence-based treatment modifications.
Methods: A systematic literature search was conducted across PubMed, Embase, Scopus, and Ovid databases through April 2025. Studies reporting on atypical or complex clubfoot characteristics, pathogenesis, management techniques, and outcomes were included. Quality assessment and data extraction followed PRISMA guidelines. A total of 32 studies met the inclusion criteria and were analyzed.
Results: Atypical clubfoot is characterized by a deep transverse plantar crease, hyperextension of the big toe, and a stubby foot appearance. Complex variants demonstrate excessive oedema and stiffness during casting. The challenges encountered during treatment are due to intrinsic anatomical factors and iatrogenic factors such as frequent cast slippage. Key management modifications include: prevention of cast slippage through metatarsophalangeal joint termination, application of the Ponseti 2 manoeuver for forefoot equinus correction, delayed tenotomy timing, and increased vigilance for recurrence. Recurrence rates range from 15-45%, higher than idiopathic clubfoot. Long-term outcomes demonstrate satisfactory correction with modified protocols, though complex clubfoot requires more casts and closer follow-up.
Conclusions: Early recognition of atypical/complex clubfoot enables timely implementation of treatment modifications. Prevention of iatrogenic cast slippage, appropriate application of the Ponseti 2 manoeuver, and extended follow-up are essential for optimal outcomes. Further research is needed to standardize terminology and establish evidence-based algorithms.
Keywords: Clubfoot, Atypical, Complex, Review

References

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How to Cite this Article: Dhar SA, Dar TA, Dar RA, Raina A, Alam M, Farooq S, Maajid A. Atypical Clubfoot- A Systematic Review. International Journal of Paediatric Orthopaedics. January-April 2026; 12(1): 02-07.

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Bilateral Trevor’s Disease of Ankle: A Rare Presentation and Treatment Consideration

DOI- https://doi.org/10.13107/ijpo.2025.v11.i03.250

Open Access License: CC BY-NC 4.0

Submitted: 29/09/2025; Reviewed: 18/10/2025; Accepted: 13/11/2025; Published: 10/12/2025

Authors: Gaurav Kumar MS Ortho [1], Amitosh Mishra D. Ortho, DNB Ortho [2], Abhishek Verma DNB Ortho [1], Anuj Rastogi D. Ortho, DNB Ortho [2]

[1] Department of Orthopaedics, Hind Institute of Medical Sciences, Sitapur, UP, India.
[2] Department of Orthopaedics, Integral Institute of Medical Sciences & Research, Lucknow, UP, India.

Address of Correspondence
Dr. Amitosh Mishra,
Department of Orthopaedics, Integral Institute of Medical Sciences & Research, Lucknow, UP, India.
E-mail: dramitoshmishra@gmail.com

Abstract

Trevor’s Disease, also referred to as Dysplasia epiphysealis hemimelica (DEH), is an uncommon skeletal developmental disorder which is characterized by an asymmetrical growth of the epiphyseal cartilage. A 5-year-old boy presented with bilateral painless swelling on the medial aspect of both feet for 3 years which had progressively increased in size. X-ray and magnetic resonance imaging (MRI) showed swelling from the inferomedial aspect of the talus. It was managed surgically by excision of the swelling. Histopathology revealed an osteochondroma of the talus arising from the epiphysis. Early diagnosis and treatment are necessary to prevent articular dysfunction of the tibiotalar and subtalar joints.
Keywords: Epiphyseal tumors, Ankle osteochondroma, Ankle swelling, Dysplasia epiphysealis hemimelica, Trevor’s disease

References

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How to Cite this Article: Kumar G, Mishra A, Verma A, Rastogi A. Bilateral Trevor’s Disease of Ankle: A Rare Presentation and Treatment Consideration. International Journal of Paediatric Orthopaedics. September-December 2025; 11(3):24-27.

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Neglected Convergent Elbow Dislocation in a Paediatric Patient: A Case Report

DOI- https://doi.org/10.13107/ijpo.2025.v11.i03.248

Open Access License: CC BY-NC 4.0

Submitted: 21/09/2025; Reviewed: 14/10/2025; Accepted: 10/11/2025; Published: 10/12/2025

Authors: Vivek Singh MS Ortho [1], Rahul Baishya MS Ortho [1], Rahul Mishra MS Ortho [1], Manish Kumar Shah MBBS [1], Dhaval Patel MBBS [1], Aditya K.S. Gowda MS Ortho [1]

[1] Department of Orthopedics, Paediatric Orthopaedics Unit, AIIMS, Rishikesh, Uttarakhand, India.

Address of Correspondence
Dr. Aditya K.S. Gowda,
Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, India, 249203
E-mail: adityajr.orth@aiimsrishikesh.edu.in

Abstract

Background: Convergent elbow dislocation is a rare paediatric injury with medial translocation of both radius and ulna. Subtle radiographic signs lead to missed diagnoses and delayed treatment.
Case presentation: We evaluated an 11-year-old girl with persistent restriction of forearm rotation and ulnar-nerve symptoms two months after a “simple” elbow dislocation that underwent a closed reduction. The diagnostic work-up included targeted review of the radiographs and non-contrast computerized tomography (CT). Operative management was performed through a posterior approach to the elbow with release of the scar tissue, ulnar-nerve decompression, open reduction, and Kirschner wire (K-wire) stabilization of the radiocapitellar joint.
Results: Pre-operative imaging confirmed convergent radioulnar translocation and anterior calcification (“radial horn”). After K-wire removal and rehabilitation, the patient achieved functional pronation–supination and resolution of ulnar neuropathy. At 24 months follow-up, radiographs showed maintained reduction and a stable, painless elbow with symmetric range of motion.
Conclusions: In the management of trauma to the elbow in children, post-reduction restriction of forearm rotation should raise the suspicion of rare injury patterns such as convergent radioulnar dislocation. In case of delayed presentation, prompt recognition and comprehensive soft-tissue release with nerve decompression can yield excellent function.
Keywords: Elbow dislocation, Convergent dislocation, Child, Ulnar neuropathy, Open reduction.

References

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How to Cite this Article: Singh V, Baishya R, Mishra R, Shah MK, Patel D, Gowda AKS. Neglected Convergent Elbow Dislocation in a Paediatric Patient: A Case Report. International Journal of Paediatric Orthopaedics. September-December 2025; 11(3): 20-23.

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Unilateral Perthes Disease Followed by Contralateral Pre-slip SCFE: A Case with Sequential Hip Disorders

DOI- https://doi.org/10.13107/ijpo.2025.v11.i03.246

Open Access License: CC BY-NC 4.0

Submitted: 19/09/2025; Reviewed: 30/09/2025; Accepted: 24/11/2025; Published: 10/12/2025

Authors: Tariq Altaf Mir MS Ortho [1], Muhammad Haseeb Gani MS Ortho [1]

[1] Paediatric Orthopaedics Department, Paras Health, Srinagar, India.

Address of Correspondence
Dr. Tariq Altaf Mir,
Consultant, Paediatric Orthopaedics Department, Paras Health, Srinagar, India.
E-mail: mirdadtariq@protonmail.com

Abstract

Background: Perthes disease and Slipped Capital Femoral Epiphysis (SCFE) are distinct paediatric hip disorders, rarely reported to occur sequentially in the same patient.
Case report: We report a case of a 7-year-old boy with Perthes disease of the Right hip treated by proximal femoral osteotomy. At the age of 9 years, he complained of Left hip pain, which on evaluation was found to be a pre-slip SCFE. He underwent in-situ pinning on the Left side and was asymptomatic at the last follow-up.
Conclusion: Recognition of this sequential presentation is important for surveillance and timely management.
Keywords: SCFE, Perthes disease, Vitamin D deficiency

References

1. Karkenny AJ, Tauberg BM, Otsuka NY. Pediatric hip disorders: Slipped capital femoral epiphysis and Legg-Calvé-Perthes disease. Pediatr Rev. 2018 Sep;39(9):454–63. doi:10.1542/pir.2017-0197. PMID: 30171056.
2. Markheim HR. Legg-Perthes disease and slipped epiphysis in the same patient: a case report. J Bone Joint Surg Am. 1949;31A:666–8.
3. Graziano GP, Kernek CB, DeRosa GP. Coexistent Legg-Calvé-Perthes disease and slipped capital femoral epiphysis in the same child. J Pediatr Orthop. 1987;7:61–2. doi:10.1097/01241398-198701000-00012.
4. Singh KA, Madegowda A, Shah H. Slipped capital femoral epiphysis in a healed Perthes hip. BMJ Case Rep CP. 2021;14:e243977.
5. Madhuri V, Arora SK, Dutt V. Slipped capital femoral epiphysis associated with vitamin D deficiency: a series of 15 cases. Bone Joint J. 2013 Jun;95-B(6):851–4. doi:10.1302/0301-620X.95B6.30806. PMID: 23723284.

How to Cite this Article: Mir TA, Gani MH. Unilateral Perthes Disease Followed by Contralateral Pre-slip SCFE: A Case with Sequential Hip Disorders. International Journal of Paediatric Orthopaedics. September-December 2025; 11(3): 16-19.

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