A rare three part proximal ulnar shear fracture requiring innovative reduction and fixation in a paediatric elbow.

Fracture of the proximal ulna in children is an uncommon injury with various classification models. An 8-year-old boy presented to our emergency department with an isolated three part intra-articular fracture of his right proximal ulna from an extension injury sustained during skiing which has not been previously described in the literature. He was taken to the operating room for open reduction and internal fixation. Two cannulated screws positioned in a posterior-anterior direction were used to hold the reduction. He was discharged from the hospital 24 h post-reduction in a complete cast. At 5 weeks follow-up, his elbow radiographs indicate no loss of reduction and at 4 months follow-up, he has regained a full range of movement at the elbow joint. The cannulated screws were left in situ as it did not cause him any harm. We propose that the described fracture pattern should be managed by open reduction and internal fixation (cannulated screws used to hold the reduction, position in a posterior-anterior direction).

Three-dimensional analysis of the palmar plate and collateral ligaments at the proximal interphalangeal joint.

The purpose of this study was to analyze the palmar plate complex at the proximal interphalangeal joint using a three-dimensional (3D) technique, which makes it easier to understand the dimensions of structures and their relationship to the adjacent components. This method allows individual elements to be removed virtually, facilitating clearer observation of each component. Sixteen cadaveric specimens were dissected and reconstructed in a 3D virtual environment. The palmar plate is made up of a distal, fibrous portion and a proximal, membranous portion, which anchors distally on the base of the middle phalanx and is continuous with the bilateral check-rein ligaments proximally. The accessory collateral ligaments and the A3 pulley suspend the palmar plate laterally.

Neonatal hip septic arthritis: ultrasound should not influence decision to aspirate.

An 18-week-old boy presented to the emergency department with 24-h history of fever and irritability with a painful left hip held in flexion. Blood tests showed an elevated ESR of 65 mm/h, but white cell count and C-reactive protein were in the reference range. Admission hip ultrasound identified a small effusion (<2 mm at the recess), not large enough to determine turbidity. Joint aspiration under general anaesthesia yielded frank pus and mandated open arthrotomy. Physicians must maintain a high index of suspicion of hip septic arthritis irrespective of ultrasound findings and have a low threshold for joint aspiration. Aspiration 'to dryness' would have left substantial pus within the joint and is consistent with advocating arthrotomy and washout in this age group, when the diagnosis of septic arthritis has been made.

The management of weakness caused by lumbar and lumbosacral nerve root compression.

Spinal stenosis and disc herniation are the two most frequent causes of lumbosacral nerve root compression. This can result in muscle weakness and present with or without pain. The difficulty when managing patients with these conditions is knowing when surgery is better than non-operative treatment: the evidence is controversial. Younger patients with a lesser degree of weakness for a shorter period of time have been shown to respond better to surgical treatment than older patients with greater weakness for longer. However, they also constitute a group that fares better without surgery. The main indication for surgical treatment in the management of patients with lumbosacral nerve root compression should be pain rather than weakness.