We present the unusual case of a 54-year-old diabetic man with chronic suppurative otitis media, presenting with cervical osteomyelitis and retropharyngeal abscess. This was treated with decompression, debridement and fusion from C2 to C4 with external halo-frame stabilization. Pseudomonas aeruginosa was cultured from the ear and the osteomyelitis specimen. Exploration of the left ear showed evidence of mucosal disease, with granulations in the middle ear and oedematous mucosa in the mastoid antrum, but no evidence of dural-plate dehiscence. Haematogenous spread probably led to cervical osteomyelitis and retropharyngeal abscess formation. Cervical osteomyelitis may develop as a rare complication and present as a cause of severe neck pain in patients with otitis media.

Objective: To evaluate the differences in the presentation, their operative implications and difficulties of single stone versus multiple gall stone disease.Methods: This is a prospective study of a minimum of 60 patients with gall stone disease (Group 1-single, Group 2-multiple) from January 2019 to December 2019 in KGH, Visakhapatnam.Results: More common in females, 40-50 years symptoms and complications, TC count difficult cholecystectomies were more in multiple gall stone pts.Conclusion: Multiple gall stones have led to more severe symptoms and complications and difficult surgery. should be motivated for early surgery even in incidental finding and should not opt for conservative management.

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Intra-medullary nailing is a standard form of treatment for diaphyseal tibial fractures. Insertion of the nail requires threading of the nail over a smooth guide-wire. Inadvertent complications during this stage have been reported. We report a case of inadvertent penetration of the tibio-talar joint by the smooth guide wire caused by incarceration of a fracture fragment between the nail and the guide wire at the time of insertion. This was noted intra-operatively. The guide-wire and the nail were removed followed by insertion of a new nail and completion of the procedure. The patient did not have any symptoms attributable to this at the time of healing of her fracture. Case presentationA 54 year old Sri Lankan woman was admitted for management of a grade 1 open fracture of both bones of her right leg. She also had a proximal humerus fracture on the left shoulder. After preliminary care in the emergency room, she was taken up for definitive surgical treatment of her fractures. The wound in her right leg was excised and primarily closed. This was followed by intra-medullary nailing of the tibia. A knobbed guide-wire was inserted through a patellar tendon-splitting approach through the tibial tubercle. This was followed by reaming of the medullary canal. The knobbed guide-wire was exchanged for a smooth guide wire followed by insertion of the nail. As the nail was hammered inside, a prominence was felt on the skin of the sole. Checking under image intensifier revealed that the guide-wire had penetrated the ankle and the sub-talar joint (Figure 1). The nail along with the guide-wire was removed and examined. This revealed incarceration of a fragment of bone between the guidewire and nail preventing smooth sliding of the nail on the guide-wire (Figure 2). This had caused the nail and the guide-wire to move as a single piece resulting in penetration of the ankle and sub-talar joint by the guidewire. A new guide-wire was inserted followed by completion of the nailing (Figure 3).At the time of the last follow up, the patient did not have any residual ankle problems attributable to the complication.