Hematogenous pyogenic vertebral osteomyelitis (VO) is a rare and often fatal complication of osteomyelitis that can affect individuals with underlying medical conditions, hospital-acquired infections, and intravenous (IV) drug abuse. Pyogenic vertebral osteomyelitis can present with generalized back pain, pyrexia, motor weakness, and neurologic deficits. The enigmatic presentation of this condition often results in delays in diagnosis and an increase in mortality. This case report aims to bring awareness to complications of hematogenous pyogenic vertebral osteomyelitis as well as highlight the need for further studies in order to establish standardized treatment. In our report, we depict a case of complicated pyogenic VO that required pharmacological and surgical intervention.

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The princeps pollicis artery (PPA) is typically a direct branch off the deep palmar arterial arch. Identified is a 90-year-old female cadaver in which the right hand has a duplicated PPA and radialis indicis (RI) artery. These vessels originate from the superficial palmar arterial arch as variant vessels as well as from the deep palmar arterial arch. The superficial arch appears in its classic pattern, while the duplicate PPA and RI present at the radial aspect of the superficial arch in the volar first web space with clear communication to the superficial radial artery. There are many common surgical procedures that require precise knowledge of the first web space, such as Dupuytren's contracture release, trigger thumb release, and syndactyly release at the first web space. Further, percutaneous pinning of fractures at the base of the thumb may pose an inherent risk to the underlying vessels. Understanding these variations of hand vasculature is of clinical significance in disciplines such as orthopedic surgery, plastic surgery and vascular surgery.