Twin trouble: osteomyelitis as a complication of abnormal fetal presentation

Neonatal osteomyelitis and septic arthritis are rare but serious conditions that can arise in the first few weeks of life. The main risk factors for neonatal bone and joint infections include chorioamnionitis, perinatal asphyxia, prematurity, sepsis, invasive lines and procedures, mechanical ventilation, urinary tract infection and skin lesions. The risk factors related to birth trauma like breech delivery and nerve palsies of the upper extremity have been described but are relatively uncommon. Here, we discuss two interesting but similar cases of osteomyelitis affecting two pairs of twins, where only one of the twins in each pair developed osteomyelitis. The common association between them was breech presentation with difficult extraction.