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Septic Arthritis of the Hip Complicating Osteomyelitis of the Ischium

Nouh, F, MBBS, BSc; Visvanathan, S, MBBS, BSc; Mourad, M S., MBBS; Konidaris, G, MBBS; Van der Wall, H, MBBS, PhD, FRACP; Bruce, W M., MBBS, FRACS, FAOrthA

doi: 10.1097/01.rlu.0000135268.88876.5b
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A 54-year-old man with quadriplegia secondary to multiple sclerosis was admitted with an infected pressure ulcer over the right ischium. Surgical treatment included debridement and application of a vacuum dressing to the ulcer. Culture of bone scrapings from the ischium grew diphtheroids and anaerobic species. Appropriate broad-spectrum antibiotics were started. Bone scintigraphy at this time showed intense hyperemia in the right hip with increased delayed uptake in the ischium, femoral neck, and head. A leukocyte/colloid study confirmed septic arthritis and osteomyelitis of the right proximal femur. The septic arthritis/osteomyelitis was thought to be secondary to a soft-tissue communication between the ischial ulcer and the right hip. This was confirmed by subsequent surgery.

From the Department of Orthopedic Surgery & Nuclear Medicine, Concord Hospital, Sydney, Australia.

Received for publication October 8, 2003; accepted December 31, 2003.

Reprints: H. Van der Wall, MBBS, PhD, FRACP, Department of Nuclear Medicine, Concord Hospital, Concord 2139, Australia; E-mail: hansv@nmrf.org.au.

© 2004 Lippincott Williams & Wilkins, Inc.