A unicameral bone cyst (UBC) may require surgery if its location increases the risk for pathologic frac- ture, or if it is painful or increasing in size. This case series demonstrates that curettage and grafting with a bone graft substitute alone can result in healing of the UBC. Three children with UBC and patho- logical fractures were treated with curettage and grafting using bone graft substitute beta-tricalcium phosphate granules (CHRONOS). All three went on to full union of the fracture and good consolidation of the graft with small residual cysts (Neer/Cole grades II). Curettage and grafting using CHRONOS granules is an effective way of treatment of UBC. By using this method, we were able to avoid the ne- cessity of obtaining bone graft in young patients. It shortened operative time and avoided donor site morbidity.

Bone graft harvesting from the iliac crest is a common procedure. However, this procedure may be associated with a number of minor and major complications leading to morbidity. Herniation through an iliac crest defect is a rare complication of this procedure. We report the case of a 65-year-old obese lady who developed hernia through the iliac crest defect after bone graft harvesting. This was managed by repair of iliac crest defect with a Titanium mesh and reinforcement of the abdominal wall defect with a synthetic mesh.

Introduction: Foot infections are one of the major complications of diabetes mellitus and a significant risk factor for lower extremity amputation. Providing effective antimicrobial therapy is an important component in treating these infections. This study assesses the microbial isolates of patients with diabetic foot infections and their antibiotic susceptibility pattern. Materials and Methods: A retrospective study of 75 patients with diabetic foot infections admitted to RIPAS hospital between June 2008 and June 2010 was undertaken. Bacteriological specimens were obtained and processed using standard hospital procedure for microbiological culture and sensitivity testing. Results: Overall, 40 (54%) patients had subcutaneous infections, 22 (29%) had infected superficial ulcers, seven (9%) had infected deep ulcers involving muscle tissues and six (8%) had osteomyelitis. A total of 98 pathogens were isolated. Forty percent of the patients had polymicrobial infection, 39 (52%) had single organism and 6(8%) had no growth. Gram-negative bacteria (67%) were more commonly isolated than gram-positive bacteria (30%). The three most frequently found gram-negative organisms were Pseudomonas aeruginosa (19.4%), Klebsiella pneumoniae (15.3%), and Acinetobacter spp. (10.2%) and gram-positive organisms were Staphylococcus aureus (10.2%), Streptococcus pyogenes (7.1%) and Methicillin resistant Staphylococcus aureus [MRSA] (7.1%). Vancomycin was found to be the most effective against gram-positive bacteria while amikacin was the most effective against gram-negative bacteria based on antibiotic testing. Conclusion: In 40% of diabetic feet infection was polymicrobial. Staphylococcus aureus and Pseudomonas aeruginosa were the most common gram-positive and gram-negative organisms respectively. This study helps us to choose the empirical antibiotics for cases of diabetic foot infections.
Diabetic Complications ; Diabetic Foot ; Microbiology ; Bacteriology

A 5-month-old child was admitted to the paediatric intensive care unit with status epilepticus and cardio-respiratory arrest. Due to difficulty with obtaining intravenous access, an intraosseous infusion was started in the left proximal tibia. This was discontinued after two days. On examination there was swelling of the left leg with minimal redness. The site of infusion did not show any abnormality. A radiograph of the left leg performed on the ninth day did not reveal any abnormalities. A repeat radiograph performed on the twentieth day is shown above (Panel). What is the diagnosis? Answer: refer to page 237

(Refer to page 209) Answer: Osteomyelitis of the tibia following intraosseous infusion In critically ill or injured paediatric patients, intraosseous infusion (IO) provides rapid access to the systemic venous circulation. This has replaced venous cut-down and central line insertion in emergency situations, being included in standard protocols and training procedures recommended by most specialty associations and societies.