Necrosis of the tuberosity of the ischium mimicking neoplasm.
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Total hip arthroplasty in the high riding dislocated hip is a technically difficult undertaking, with major reconstruction required on both the acetabular and femoral sides. With reconstruction at a near-anatomic hip center, reduction of the arthroplasty is difficult because of the long-standing limb shortening. The major block to reduction is tension of the soft tissues, particularly the hamstrings. We report a case of ischial tuberosity avulsion fracture following such a complex reconstruction despite femoral shortening subtrochanteric osteotomy. This illustrates the importance of the hamstring group in maintaining the dislocation and emphasizes the need to prevent overtension of the soft tissues in such complex reconstructive procedures.
Acute hematogenous osteomyelitis of the os ischii is a rare disease. Involvement of the acetabulum in a 4-month old girl with concomitant developmental dysplasia of the ipsilateral hip caused a dislocation of the hip joint due to synovitis. Arthroscopic joint lavage, antibiotic treatment and reduction of the hip in a pavlik-harness led to a satisfactory result.
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30 children with Ewing's sarcoma, the most common malignant pelvic tumour in childhood, were analysed. The diagnosis of Ewing's sarcoma is relatively easy and can be established in most of the cases on plain radiography. The diagnostic radiographic features of the tumour are discussed. The two most important conditions in differential diagnosis are eosinophilic granuloma and the rare primary bone lymphoma. Osteomyelitis should rarely cause confusion unless the clinico-radiographic findings are not properly evaluated.
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A 7-year-old boy presented with urinary symptoms and umbilical discharge. A perivesical abscess was drained from which Staphylococcus aureus was cultured. He responded to antibiotics. Subsequently, he developed a discharging sinus in the gluteal region. A plain radiograph, which had previously been normal, confirmed osteomyelitis of the ischial bone.
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