Turret exostosis of the talus.

Turret exostosis is a benign osteocartilagenous lesion believed to arise from reactive perisoteum following relatively mild trauma. This article presents an unusual case of a turret exostosis of the talar neck in a 12-year-old child. A healthy adolescent presented with a 5-month history of a firm, painless mass about the anteromedial aspect of the right ankle 1 month after suffering a mild twisting injury to the ankle. Radiographs demonstrated a benign-appearing bony mass within the soft tissues anterior to the right ankle overlying the talar neck. An excisional biopsy of the mass was performed and pathology was consistent with turret exostosis, demonstrating a central area of mature trabecular bone maturing via enchondral ossification with a thin hypocellular peripheral rim of cartilage. The absence of a periosteal layer, abundant "blue bone," bizarre metaplastic cartilage, or marked cytologic atypia confirmed the diagnosis. The patient remains pain free with full ankle motion. Reactive periosteal lesions are well-described entities, tending to occur with the greatest frequency in the small bones of the hand. Few cases of bizarre parosteal osteochondromatous proliferation in the metatarsals and phalanges of the toes have been reported. The current case represents the first account of a turret exostosis of the hindfoot, and the youngest patient with a histologically confirmed diagnosis. It further illustrates the manner in which this case exists along a continuous spectrum of reactive periosteal lesions. The clinical, radiographic, and histologic characteristics of reactive periosteal lesions are reviewed.

Salmonella osteomyelitis in new-onset diabetes mellitus.

Salmonella species are rare bacterial isolates in osteomyelitis. This article describes a case of an otherwise healthy, active duty male military member with an insidious onset of right knee pain during a deployment to Kuwait. His work-up revealed an infectious process in the distal femur. Operative treatment and intravenous antibiotics resolved the infection. Intraoperative cultures revealed the rare isolate Salmonella enterica serotype C2 (Newport). Postoperative medical management revealed new-onset diabetes mellitus, possibly making this otherwise healthy host susceptible to this rare infection. Salmonella are gram-negative bacteria. Infection with nontyphoidal Salmonella species most commonly manifests as intestinal illness. Although it may be difficult for clinicians to accurately predict this rare entity as the causative organism in osteomyelitis, they may be aided by a history of travel to endemic regions or exposure to animal carriers. Comorbidities that seem to increase susceptibility include diabetes mellitus, human immunodeficiency virus, hemoglobinopathies, and immunosuppression. Blood cultures are reported to be frequently positive in cases of Salmonella osteomyelitis. Identification of Salmonella species from intraoperative cultures should prompt consultation with the infectious disease department for culture-specific antibiotic tailoring. Many common antibiotic agents active against gram-negative organisms seem efficacious. As in this case, following the basic tenets of osteomyelitis management should lead to an acceptable outcome.