Pyogenic sacroiliitis (PSI) is an uncommon form of septic arthritis and is frequently diagnosed late in older adults because initial symptoms are nonspecific and imaging findings may be misattributed to other sources of infection. We report two older patients with PSI complicated by massive retroperitoneal and gluteal abscesses, highlighting the importance of early recognition and, when indicated, timely surgical source control. Case 1 was an 83-year-old woman in whom a conspicuous retroperitoneal abscess and abnormal urinalysis led to suspicion of an intra-abdominal or urinary tract source, delaying recognition of PSI. Despite antibiotics, she deteriorated with organ dysfunction; re-evaluation of the initial magnetic resonance imaging MRI identified the sacroiliac joint as the primary focus, and staged surgical drainage procedures were required, followed by a prolonged recovery. Case 2 was a 70-year-old woman who presented in septic shock after failing outpatient treatment for presumed lumbar spine disease. Based on the diagnostic pitfalls in Case 1, PSI was immediately suspected; emergency drainage of both retroperitoneal and gluteal collections was performed on the day of presentation, which was followed by rapid stabilization and recovery. These cases emphasize that, in older patients with low back or gluteal pain, the concurrent presence of retroperitoneal and gluteal abscesses should prompt careful evaluation of the sacroiliac joint. These observations suggest that early diagnosis and timely assessment for surgical source control may contribute to favorable outcomes in severe cases.
Retroperitoneal hemorrhages are an uncommon but potentially fatal complication in the setting of recent spine surgery. Patients generally report lower abdominal or groin pain, and they may demonstrate signs of hemodynamic instability. Prompt recognition of retroperitoneal hemorrhages requires a thorough history and physical examination, monitoring of appropriate laboratory values, and often advanced imaging. Whereas treatment can occasionally be achieved with conservative measures, retroperitoneal hemorrhage is most commonly treated with embolization. We present a case of spontaneous retroperitoneal hemorrhage after percutaneous L3 to pelvis posterior spinal instrumentation and L4–L5 posterolateral fusion with allograft. In our case, the patient was noted to be hypotensive and began reporting right lower quadrant abdominal pain on postoperative Day 2. Investigation with computed tomography angiography revealed a right retroperitoneal hematoma with small areas of active bleeding, ultimately requiring an embolization procedure with interventional radiology. The patient was last seen for a 1-year follow-up, at which time he demonstrated 5/5 motor strength and fully intact sensation throughout L2–S1 of the bilateral lower extremities. He complained of mild right lumbar pain over the region of hardware after recently losing approximately 30 pounds and recent balance issues. This case highlights common presenting signs/symptoms of a relatively uncommon and potentially fatal complication in the setting of percutaneous spinal surgery; we hope to increase awareness and improve prompt recognition among providers to help minimize serious complications for patients.
Background Common peroneal nerve palsy (CPNP) is an uncommon but potentially disabling complication of primary total knee arthroplasty (TKA). It typically presents with weakness of ankle and toe dorsiflexion, foot drop, a steppage gait and reduced or absent sensation over the dorsum of the foot. Delayed recognition or inadequate management may lead to atrophy of the anterior and lateral compartment muscles and persistent disability. Case presentation We report a 72‐year‐old woman who developed an acute, complete CPNP with foot drop and dorsal foot sensory loss on the first day after primary right TKA. Management was nonoperative and centred on early limb repositioning, ankle‐foot orthosis (AFO) support and a structured physiotherapy programme that included neuromuscular electrical (faradic) stimulation. Full neurological recovery was achieved 115 days after surgery, with normal muscle power and no residual sensory deficit. Conclusion Complete CPNP after TKA carries a less favourable prognosis than incomplete palsy, yet this patient regained full function within approximately 4 months of conservative care underscoring that, in the absence of a compressive lesion or progressive deficit, early nonoperative management with orthotic support and physiotherapy can achieve excellent recovery and that surgical exploration can reasonably be reserved for deterioration or failure to improve.
This case report describes a very rare presentation of multifocal diabetic foot osteomyelitis (DFO) involving multiple rays and associated with forefoot Charcot neuroarthropathy. Based on magnetic resonance imaging findings and subsequent histopathological examination, the osteomyelitis was confirmed to be confined to the second and third metatarsals, the proximal phalanges of the hallux and second toe, and the metatarsal head and proximal phalangeal base of the fourth ray. Treatment consisted of complete resection of all infected bone in accordance with the principles of internal pedal amputation. The defects created following second-ray metatarsectomy and proximal phalangectomy of the hallux were filled with antibiotic-impregnated bone cement. At the 1-year follow-up, following this limb-sparing procedure, the patient was pain-free, free of infection, and able to bear full weight.
Proximal avulsion of the rectus femoris tendon is an uncommon injury in athletes and is rarely associated with direct trauma and extensive hematoma. We describe a 25-year-old competitive taekwondo athlete who developed acute hip flexor weakness and thigh swelling after a direct anterior thigh kick. Bedside musculoskeletal ultrasound demonstrated disruption of rectus femoris architecture with intramuscular hematoma, and magnetic resonance imaging confirmed complete avulsion of both proximal heads of the rectus femoris with tendon retraction and a large associated hematoma. The patient had sustained a recent prior quadriceps injury with hematoma. Recurrent hematoma development warranted hematologic testing, which revealed an isolated Factor VIII deficiency. Given his high functional demands, he underwent open surgical repair. This case highlights the importance of early imaging and consideration of operative management in high-level athletes presenting with trauma-related rectus femoris avulsion. It also highlights the importance of hematologic workups in athletes presenting with unexplained recurrent hematomas to effectively risk-stratify surgery and return to sport.
