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UNASSIGNED: Posterior cruciate ligament (PCL) tears in young children are rare and optimal treatment is poorly described. Diagnosis may prove challenging as young children may not be able to verbalize a complete history of injury, may be difficult to examine, and plane film radiographs often appear within normal limits. Surgical treatment carries a risk of physeal arrest, but non-operative treatment may lead to recurrent instability and pain.
UNASSIGNED: We present a case report of a fouryear- old child with a PCL avulsion off the femoral insertion who received an open reduction and internal fixation (ORIF) with combined arthroscopic synovial debridement. We performed a literature review which compared the mechanism, location, concomitant injuries, work up and management of PCL injuries in children under the age of ten compared to adolescents and adults.
UNASSIGNED: Nineteen months following surgery, physical examination revealed full knee range of motion and return to baseline function. Imaging studies confirmed there was no evidence of physeal arrest.
UNASSIGNED: ORIF with arthroscopy can be an effective method to treat PCL avulsions in children under the age of 10 years. This is similar to other case reports which reported positive outcomes with ORIF in this population. Large studies are needed to best understand optimal treatment modalities for PCL injuries in very young children. Level of Evidence: IV.

BACKGROUND: Surgical site infection (SSI) is associated with higher medical expenses and lower patient quality of life.
OBJECTIVE: To identify specific modifiable risk factors for SSI after orthopaedic surgery for fractures caused by trauma.
METHODS: This nested case-control study used a nationwide trauma registry, the Japan Trauma Data Bank (JTDB) database. Patient data from 280 hospitals between January 2004 and May 2019 were retrieved from the JTDB. Patients with SSI and identified patients without SSI as control subjects were included, using propensity score matching adjusted for unmodifiable factors. Risk factors associated with SSI after orthopaedic trauma surgery were assessed using multi-level mixed-effects logistic regression models.
RESULTS: In total, 15,910 patients were included in the analysis. Of these patients, 377 (2.4%) had SSI. After propensity score matching, 258 patients with SSI and 2580 matched patients without SSI were selected. In the multi-level mixed-effects logistic regression analysis, blood transfusion within 24 h (odds ratio (OR): 1.51; 95% confidence interval (CI): 1.06-2.13) was a significant risk factor for SSI following orthopaedic fracture surgery. The OR (95% CI) values for external fixation, transcatheter arterial embolization, and tourniquet for SSI following orthopaedic fracture surgery were 1.40 (0.96-2.03), 1.66 (0.81-3.38), and 2.99 (0.60-14.87), respectively.
CONCLUSIONS: These findings highlight the necessity of exercising caution when implementing blood transfusion within 24 h as a risk factor associated with SSI following orthopaedic trauma surgery.

BACKGROUND: Giant cell tumor (GCT) is a benign tumor with progressive and destructive characteristics involving metaphysis, with extension to the epiphyseal tissue, en-bloc resection surgery is the main choice for surgical treatment.
OBJECTIVE: Our case report will discuss en bloc resection with pre-operative embolization for treating GCT in the sacrum to reduce the incidence of intraoperative bleeding.
METHODS: A 33-year-old woman complained of low back pain radiating to the left leg that had been present for one year. Lumbosacral X-ray examination revealed a destructive osteolytic lesion involving the sacrum I-III and left iliac bones surrounded by soft tissue mass. The surgery on the patient 24 h later included installing posterior pedicle screw instrumentation on the 3rd and 4th lumbar, iliac screw, and using bone cement. After that, we performed a curettage on the mass and filled it with a bone graft.
CONCLUSIONS: Non-surgical GCT management is effective but has a high local recurrence rate when used alongside curettage. Intralesional resection and en bloc resection are the most common surgical treatments. GCT with pathological fractures requires more invasive procedures, such as en-bloc resection, but excision can be performed to minimize surgical complications. Arterial embolization is a curative therapy for GCT sacral tumors.
CONCLUSIONS: En-bloc resection with pre-operative arterial embolization for treating GCT can reduce the incidence of intraoperative bleeding.

UNASSIGNED: Colorectal cancer rarely metastasizes to the bones, and if so, metastasis usually occurs in the axial skeleton. We encountered a rare case of a metastatic lesion to the right ulna arising from colonic adenocarcinoma that was treated by resection of the proximal ulna and radial neck-to-humerus trochlea transposition to salvage the limb.
METHODS: A 60-year-old man previously diagnosed with colonic adenocarcinoma presented with a single bony metastatic lesion in the right proximal ulna and was referred to our clinic for assessment. After five sessions of systemic therapy, the lesion continued to grow, causing diffuse swelling and loss of elbow range of motion. Local x-rays revealed extensive destruction of the proximal ulna and soft tissue component, with subluxation of the radial head. Magnetic resonance imaging showed an extensive lesion involving the proximal half of the ulna and a large soft tissue component. After restaging, only this metastatic lesion was found. Amputation was offered to the patient for wide margin resection, but the patient refused; therefore, we performed resection of the proximal ulna, debulking of soft tissue, and radial neck-to-humerus trochlea transposition to salvage the limb.
UNASSIGNED: Due to the rarity of the location, no clinical standard exists regarding the surgical treatment. Radial neck-to-humerus trochlea transposition is a valid surgical reconstruction technique to salvage the limb and preserve the hand function.
CONCLUSIONS: Radial neck-to-humerus trochlea transposition is an alternative elbow reconstruction technique after proximal ulna resection in cases where other options are not ideal or contraindicated. Long-term studies are recommended to assess different surgical options for treating and reconstructing proximal ulnar tumors.

A limited soft tissue injury known as Morel-Lavallée syndrome is brought on by the violent segregation of the dermis and subcutaneous tissue layer. Shear injury causes perforating arteries and lymphatics to burst, potentially releasing serosanguinous fluid, blood, and necrotic fat into the area. Morel-Lavallée lesions (MLL) can be accompanied by pelvic or acetabular fractures or by blunt trauma without a fracture. MLL is distinguished by enlargement, tightness, and tenderness of tissue. The skin around the lesion is frequently associated with diminished sensory perception. Plain radiography, USG, CT scan, and MRI are some of the imaging modalities that can be utilized. MLLs have a distinct location in the US, anterior to the muscle layer and posterior to the hypodermis. Morel-Lavallée lesions are frequently associated with complications as a result of delayed or inappropriate diagnosis. Surgical drainage and debridement are the standard surgical treatments for the lesion. Physiotherapy rehabilitation helps in reducing pain and regaining functional activities after the syndrome. This documentation includes the case of a 55-year-old male patient who had complaints of difficulty in moving their left leg and inability to walk. The patient was diagnosed with Morel-Lavallée syndrome left thigh and was advised physiotherapy. This study found that by employing strengthening exercises and other physical therapy interventions, after four weeks of therapy, joint degree of movement, muscular strength, and daily functioning, as well as cardiovascular and pulmonary capabilities all significantly improved.

OBJECTIVE: To compare the cost of using single-use instruments (SUIs) and conventional ancillary instruments (CAIs) during osteosynthesis for distal radius fracture (DRF).
METHODS: We conducted a prospective, monocentric study of ancillary instruments, including a cost minimisation analysis by micro-costing. DRF reduction and postoperative complications were monitored for 3 months.
RESULTS: In 103 procedures, the overall cost and operating times were similar between the two groups. The costs of using unit screws, sterilisation, and operating room and pharmacy staff were superior when using SUIs, compared with CAIs. The postoperative outcomes were comparable between groups.
CONCLUSIONS: In our centre, SUI use was associated with logistical advantages, but it was not associated with increased costs. However, the SUI kit should be optimised in the future.

Due to incompatibility with magnetic resonance imaging, patients with left ventricular assist devices (LVADs) presenting with pathologies of the spinal soft tissues or neural elements represent diagnostically complex cases. We present a case of a patient undergoing a CT (computed tomography) myelogram and subsequent successful cervical posterior laminectomy. A C1-C2 lateral puncture approach CT myelogram revealed nearly a complete block of contrast movement at the level of the C2-C3 vertebrae concerning a compressive etiology. The cervical lateral approach was chosen based on patient symptomology and concern that contrast dye injected in the lumbar spine would not travel to the region of interest due to altered CSF pulsatility caused by the LVAD device. A C3-C7 posterior laminectomy was then successfully performed. Intra-operatively, however, there was no sign of a compressive lesion, and ultrasound confirmed a decompressed spinal cord. This case highlights the diagnostic challenges of pre-operative evaluation in patients with LVADs in which the efficacy of performing CT myelograms is also questionable due to potential alterations in cerebrospinal fluid movement due to variations in arterial pulsatility due to LVAD physiology.

A 21-year-old otherwise healthy male sustained a nondisplaced, intertrochanteric fracture of the left femur after being \"rear-ended\" by a motor vehicle while riding his bicycle. His fracture was managed with protected weight-bearing and progressive mobilization. No traction was utilized. The patient had an excellent clinical outcome at two-year follow-up, reporting modified Harris Hip Score 85, Hip Outcome Score-Activities of Daily Living 88, Hip Outcome Score-Sport Specific 89, and International Hip Outcome Tool-33 of 77.
Nonsurgical treatment, consisting of restricted weight-bearing, for non-displaced intertrochanteric femur fracture in young, healthy patients can provide a successful result.Level of Evidence: V.

BACKGROUND: Current evidence for flexor tendon repair management and outcomes performed at peripheral centres is unclear. Most studies are based on evidence from specialist hand centres. This study evaluated a peripheral hospital in New Zealand; where all flexor tendon repairs were performed by a generalist Orthopaedic service. The purpose of the study was to benchmark management and outcomes from a peripheral hospital in comparison to international standards.
METHODS: A retrospective single-centre consecutive case series of Zones I and II flexor tendon repairs was extracted between 1 January 2014 and 1 January 2018. Medical records were used to evaluate management and outcomes of repairs. Hand therapy notes were used to evaluate rehabilitation protocols provided. The primary objective was to measure re-rupture and re-operation rates. Secondary objectives included auditing operative management and hand therapy compliance.
RESULTS: Forty-six patients (76 tendon repairs) were included in our final analysis. Mean follow up time to last clinical appointment was 11.8 weeks, and to last patient episode was 4.9 years. Most patients received timely surgery with a four-core repair using 3-0 or larger suture. All hand therapy followed a controlled active motion protocol. The re-operation rate was 19.6% (P = <0.05) and the re-rupture rate was 8.7% (P = 0.28).
CONCLUSIONS: Most flexor tendon injuries at this peripheral centre were managed according to international standards. However, high complication rates including re-operation and re-rupture occurred. Due to a lack of local comparison studies, confounding factors cannot be excluded as a contributor for these results.