Blog Multi Author - International Journal of Paediatric Orthopaedics

The Gliding Surgical Drapes Near the Periarticular Region: A Potential Source of Surgical Contamination

DOI- https://doi.org/10.13107/ijpo.2026.v12.i01.262

Open Access License: CC BY-NC 4.0

Submitted: 23/09/2025; Reviewed: 19/10/2025; Accepted: 14/01/2026; Published: 10/02/2026

Authors: Md Zafar Iqbal MS Ortho [1], Anil Agarwal MS Ortho [1], Sunny Bhalla MS Ortho [1]

[1] Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, New Delhi, India

Address of Correspondence

Dr. Md Zafar Iqbal,
Senior Resident, Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, New Delhi, India
E-mail: docmdzafariqbal@gmail.com

Abstract

In surgeries involving joints and the adjacent area, maintaining a sterile field is essential for preventing postoperative infections. The responsibilities are heightened when the joint is required to be exposed. An often-overlooked source of contamination is the gliding motion of the drapes from manipulation of the limb during surgery. We found the movement akin to the tendon glide in contaminated animal bites, where movement draws pathogens deep into the joint, increasing the infection risk. This article presents a practical tip: recognizing this gliding drape as a surgical contaminant and suggesting methods to prevent it.
Keywords: Surgical drapes, Human/animal bite, Contamination, Sterility

References

1. Noordin S, McEwen JA, Kragh CJ Jr, Eisen A, Masri BA. Surgical tourniquets in orthopaedics. J Bone Joint Surg Am. 2009;91:2958-67.
2. Armstrong M, Spencer R. Tourniquet use in orthopaedic surgery. J Perioper Pract. 2011;21:319-22.
3. Tintle SM, Forsberg JA, Keeling JJ, Shawen SB. Infectious complications of animal bites involving the upper extremity. J Hand Surg Am. 2010;35:476-9.
4. Walsh EF, Ben-David D, Ritter M, Mechrefe A, Mermel LA, DiGiovanni C. Microbial colonization of tourniquets used in orthopedic surgery. Orthopedics. 2006;29:709-13.
5. Ahmed SM, Ahmad R, Case R, Spencer RF. A study of microbial colonisation of orthopaedic tourniquets. Ann R Coll Surg Engl. 2009;91:131-4.
6. Mufarrih SH, Qureshi NQ, Rashid RH, Ahmed B, Irfan S, Zubairi AJ, Noordin S. Microbial colonization of pneumatic tourniquets in the orthopedic operating room. Cureus. 2019;11:e5308.

How to Cite this Article: Iqbal MZ, Agarwal A, Bhalla S. The Gliding Surgical Drapes Near the Periarticular Region: A Potential Source of Surgical Contamination. International Journal of Paediatric Orthopaedics. January-April 2026; 12(1): 19-21.

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Small Shoulders, Big Burden: Scapular Osteomyelitis in an Infant

DOI- https://doi.org/10.13107/ijpo.2026.v12.i01.260

Open Access License: CC BY-NC 4.0

Submitted: 31/10/2025; Reviewed: 24/11/2025; Accepted: 11/01/2026; Published: 10/02/2026

Authors: Dyan D’ Souza MS, MCh (Paed Surgery) [1], Karthik Shyam MD Rad [2], Binu T Kurian MS Ortho [3], Shubha A M MS, MCh (Paed Surgery) [1]

[1] Department of Paediatric Surgery, St Johns National Academy of Health Sciences Bangalore, Karnataka, India
[2] Department of Radiodiagnosis, St Johns National Academy of Health Sciences Bangalore, Karnataka, India
[3] Department of Orthopaedics, St Johns National Academy of Health Sciences Bangalore, Karnataka, India

Address of Correspondence

Dr. Shubha A M,
Department of Pediatric Surggery, St Johns National Academy of Health Sciences Bangalore, Karnataka, India
E-mail: dramshubha@yahoo.co.in

Abstract

Background: A mass in relation to the scapula is rare in infancy, causing a diagnostic dilemma. We report a case in an infant presenting with scapular osteomyelitis and highlight the management of this condition.
Case report: A 2-month-old male child presented with an atraumatic swelling in the right scapular region with decreased movements of the upper arm for 15 days with no response to antibiotics. A diffuse firm to hard swelling in the right scapular region, with increased temperature and tenderness restricting both passive and active movements at the shoulder joint was noted on examination. Though total counts and C- reactive protein were raised, the blood culture was sterile. Plain X-ray and MRI revealed osteomyelitis of the right scapula. Biopsy further confirmed the diagnosis. Good response was noted to treatment with antibiotics and physiotherapy
Conclusion: A scapular mass without shoulder arthritis, longer duration of symptoms, negative cultures and the absence of sepsis are notable features in this case. Emphasis is on prompt diagnosis and treatment with antibiotics and appropriate physiotherapy to prevent long term complications.
Keywords: Infant, Scapula, Osteomyelitis, Antibiotics, Case report

References

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2. Dich VQ, Nelson JD, Haltalin KC. Osteomyelitis in infants and children. A review of 163 cases. Am J Dis Child. 1975 Nov;129(11):1273-8. doi: 10.1001/archpedi.1975.02120480007004. PMID: 1190158.
3. Behnke NM, Patel M, Davidson T, Arkader A. Orthopaedic case of the month: Rapidly progressive shoulder soft tissue mass in an 8-week-old girl. Clin Orthop Relat Res. 2011 Feb;469(2):624-9. doi: 10.1007/s11999-010-1710-0. Epub 2010 Dec 3. PMID: 21128034; PMCID: PMC3018191.
4. De Boeck H. Osteomyelitis and septic arthritis in children. Acta Orthop Belg 2005;71:505–15.
5. Koubaa M, Mnif H, Zrig M, et al. Acute hematogenous osteomyelitis of the scapula in children. Orthop Traumatol Surg Res. 2009;95:632–635.
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7. Fardon DF. Osteomyelitis of the scapula in an infant. Case report. Mo Med. 1970 May;67(5):299-302. PMID: 5427692
8. Rose NK, Franck LG, Celestin B, Adoubs I, Jean Bertrand KA. Osteomyelitis of the scapula in a 2-month-old infant. J. Pediatr. Surg. Case Rep. 2021; 73: 101998.
9. Meena S, Ansari MT. Osteomyelitis of scapula with secondary septic arthritis of shoulder joint in a six-month-old child. Malays Orthop J. 2013 Mar;7(1):67-9. doi: 10.5704/MOJ.1303.001. PMID: 25722810; PMCID: PMC4341052
10. Obeidat MM, Omari A. Osteomyelitis of the scapula with secondary septic arthritis of the shoulder joint. Singapore Med J. 2010;51:1–2.
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13. Unkila-Kallio L, Kallio MJ, Peltola H, Eskola J. Serum C-reactive protein, erythrocyte sedimentation rate, and white blood cell count in acute hematogenous osteomyelitis of children. Pediatrics. 1994;93(1):59–62.
14. Pratik Phansopkar, Priya tikhile, Radhika Sawal, et al. Early physiotherapy rehabilitation approach enhances recovery in rare acute tibial osteomyelitis post-operative in a 9year old child. Medical Science, 2020, 24(104), 2482-2486.

How to Cite this Article: D’ Souza D, Shyam K, Kurian BT, Shubha AM. Small Shoulders, Big Burden: Scapular Osteomyelitis in an Infant. International Journal of Paediatric Orthopaedics. January-April 2026; 12(1): 16-18.

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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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5. Giedion A, Holthusen W, Masel LF, Vischer D. Subacute and chronic “symmetrical” osteomyelitis. Ann Radiol (Paris) 1972;15:329‐42.
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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.
8. Prose NS, Fahrner LJ, Miller CR, Layfield L. Pustular psoriasis with chronic recurrent multifocal osteomyelitis and spontaneous fractures. J Am Acad Dermatol 1994;31:376‐9.
9. Wipff J, Costantino F, Lemelle I, Pajot C, Duquesne A, Lorrot M, et al. A large national cohort of French patients with chronic recurrent multifocal osteitis. Arthritis Rheumatol 2015;67:1128‐37.
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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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

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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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