An image is worth a thousand words.

INTRODUCTION: This case involved a 15-year-old boy, who slipped and impaled his left hand on a wooden beam. An initial anterior-posterior radiograph was obtained prior to referral to plastic surgery for further management (figure 1).emermed;36/2/65/F1F1F1Figure 1Clinical photographs and initial X-ray taken of the impalement injury.Clinical examination was restricted due to access. The patient reported general pain on limited movement of all digits but normal neurology. He received appropriate initial treatment of broad-spectrum antibiotics and tetanus care in the emergency department. His medical and social history were unremarkable. QUESTION: What is the next most appropriate intervention?Immediate removal of the impaled structure under tourniquet control in an operating theatre.Immediate removal of the impaled structure in the emergency department under nerve block.Further imaging is needed.Urgent surgical consultation.

A Rare Case of Primary Tuberculous Tenosynovitis in a Young Patient with an Acute History.

We present a rare case of primary tuberculous tenosynovitis in a young patient with an acute history of non-penetrating traumatic injury. The patient had recently visited Pakistan and presented with sudden onset pain at the base of their right fifth digit after trying to catch a cricket ball. A provisional diagnosis of haematoma was made; however, ultrasonography revealed a mass attached to the A2 pulley. Surgical excision followed by histological examination and culture identified Mycobacterium Tuberculosis infection. This case serves to raise clinical awareness of this rare condition and highlight the importance of obtaining a travel history.

Burns in patients over 90: a fifteen-year series from a regional burns centre.

The elderly constitute an expanding subgroup within society, and may have differences in health needs compared to younger patients. The specific needs and outcomes of elderly patients with burns have been widely studied. However, the definition of elderly often used in previous studies is a cut off of 65 years old. Within this broadly defined group, the very elderly may have distinct health care needs and issues. This study investigated aetiology, management and outcome of burns in those over 90 years treated at a single UK burns service over a period of 15 years between 1998 and 2013, and compares these data to published data describing 'younger' elderly burns patients. Twenty two patients were included, with a 2:1 female:male ration, and a mean 9%TBSA burn. Six of the 22 died during their admission, and those who survived averaged 8 days inpatient stay per %TBSA. The very elderly with burns may fare worse than younger elderly patients. Although burns in the very elderly are relatively infrequent events, they require significant resource. Further work to optimise their outcome is required.

Tumour to tumour metastasis of malignant melanoma to intracranial tumour.

UNLABELLED: Tumours can metastasize to sites of other tumours but this is a rare event. The phenomenon has been well described in primary tumours of the lung and breast. This has been described in melanomas but as very rare occurrence. We describe a case of a malignant melanoma that metastasized to a pre-existing meningioma. We have tried to highlight this phenomenon in patient with melanoma and need for close vigilance of other pre-existing tumours to identify early metastasis. KEYWORDS: Melanoma; Metastasis; Tumour to Tumor; Intracranial; Meningioma.

Solitary plasmocytoma of frontal bone presenting as an asymptomatic forehead lump.

Solitary plasmocytoma of bone is a rare type of plasma cell tumor. We present a case of a solitary extramedullary plasmacytoma of the frontal bone presenting as an asymptomatic forehead lump with clinically benign characteristics. This case highlights the need for a high index of suspicion when dealing with enlarging subcutaneous lumps of the forehead and scalp. The significance of this lies in the appropriate sequencing of investigations and the implementation of the necessary treatment regimen.

Bilateral radial head fractures in a woman with trivial trauma.

Radial head fractures are common injuries, occurring in about 20% of all acute elbow injuries. Isolated radial head fractures are not common and include about 2% of all fractures around the elbow. Bilateral radial head fractures are rare and usually associated with severe trauma and associated fractures and dislocations. We report a case of bilateral undisplaced radial head fracture in a woman, following a simple fall. Early recognition, proper management, and physical therapy led to complete recovery and full functional movement of the elbow.