PMC7082595_01
(A). Plain radiology findings: signs of osteopenia, the thick sclerotic metaphyseal line above a widened physis, and small beak-like excrescences at the metaphysis of both tibias, (B). High signal intensity and fluid-fluid levels on T2-weighted images on the proximal tibia. Based on MRI examination we suggest an osteomyelitis, (C). Clinical sign: swelling, unwilling to bear weight.
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We could also see a radiolucent shadow at proximal physis of the tibia and periosteal elevation (Fig. 1). T2-weighted images. The subperiosteal fluid collection had low signal intensity on T1-weighted images and high signal intensity and fluid-fluid levels on T2-weighted images. The periosteum and surrounding muscles of the leg were moderately enhanced on contrast-enhanced fat-suppressed T1-weighted images (Fig. 1).
(A). Intraoperative findings; subperiosteal hematom; new bone formation; no pus; no cortical destruction; intramedullary hematoma, (B). One week post operative plain radiology finding: 1. Frankel Line; 2. Trummerfild zone (Scorbutic zone); 3. Ring epiphysis (Wimberger); 4. Pelkin spur; 5/6. Periosteal elevation (subperiosteal hematom) with new bone formation; 7. Epiphyseal slidesexamination, and (C). Corkscrew hairs.
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No sign of infection nor cortical destruction, A window was made over the cortex of proximal part followed by intramedullary cavity curettage and only revealed blood clot. (Fig. 2). Two weeks after surgical debridement and antibiotics administration there was still not much improvement (Fig. 2).
(A). Two months after high dose vitamin C treatment, (B) One year after high dose vitamin C treatment, (C). Painless and normal ambulation.
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Those improvements persisted after one year followed up (Fig. 3).