We describe a case of an isolated medial cuneiform avulsion fracture in a 38-year-old man following a motorcycle fall. The patient underwent open reduction and internal fixation, regaining full function by four months postoperatively. An isolated avulsion fracture of the medial cuneiform can result from an external rotation force applied to a plantar flexed foot, coupled with a forceful active contraction of the Posterior Tibial Tendon (PTT), particularly in Olewnik's Type-I anatomical variant. Awareness of anatomical variants of PTT insertion and understanding the fracture morphology and displacement, helps in selecting appropriate fixation strategies in an isolated medial cuneiform fracture.
Background Pelvic fractures from high-energy trauma are frequently complicated by urethral injury. The World Society of Emergency Surgery (WSES) and the American Association for the Surgery of Trauma (AAST) recommend retrograde urethrogram as the first-line diagnostic test for suspected urethral disruption, performed prior to any catheterization attempt. When urethral injury is confirmed, the American Urological Association advises suprapubic tube placement as the preferred initial management to avoid exacerbating injury, with endoscopic or fluoroscopic techniques reserved for select cases in which standard approaches fail or are not feasible (Coccolini et al., 2019; McCormick et al., 2023; Morey et al., 2021) [1], [2], [3]. Case presentation We report the case of a 43-year-old male involved in a high-speed motorcycle collision who presented in hemorrhagic shock with multiple injuries, including complex pelvic ring fractures and blood at the urethral meatus. A retrograde urethrogram demonstrated urethral extravasation near the pubic symphysis. During emergent operative exploration for associated thoracoabdominal injuries, the urology team performed intraoperative flexible cystoscopy. The disrupted urethral tract was identified at the 12 o'clock position, and a 0.035-inch guidewire was advanced into the bladder under direct vision. A 16 Fr council-tip Foley catheter was successfully placed over the wire, achieving urinary drainage and avoiding further urethral trauma. The patient subsequently underwent interventional radiology-guided bilateral internal iliac artery embolization for ongoing pelvic bleeding and staged orthopedic fixation of pelvic fractures. Urethral healing was supported with long-term catheterization, and the patient was discharged on hospital day 31with the Foley catheter in situ for continued urologic follow-up. Conclusion This case demonstrates that video fluoroscopy and flexible cystoscopy can facilitate safe guidewire-assisted catheter placement in complex pelvic trauma when conventional methods are unsuccessful. However, current guidelines from the World Society of Emergency Surgery, the American Association for the Surgery of Trauma, and the American Urological Association support suprapubic tube placement as first-line management, with endoscopic realignment reserved for experienced providers and specific indications (Coccolini et al., 2019; McCormick et al., 2023; Morey et al., 2021) [1], [2], [3].
Introduction:Acute closed trauma to the long fingers and thumb presents a therapeutic challenge. Ultrasound refines clinical examination and enables optimal management. This study aims to assess the role of ultrasound in the management of acute closed trauma of the fingers and the thumb during post-emergency consultations. Method:Patients were re-evaluated within 15 days of their initial emergency visit. The evaluation combined a clinical examination and a standardized ultrasound assessment. Based on ultrasound findings, initial management was either confirmed or modified. The primary endpoint was the modification of initial management. Secondary endpoints included the evaluating of PRWE-Fr and QuickDASH scores and assessing of changes in the work absence duration. Results:Twenty-seven patients were evaluated, with a minimum clinical follow-up of three months. The mean age was 33 years. The thumb and the proximal interphalangeal joint were the most frequently affected fingers and joints, respectively. Ultrasound led to modifications in initial management in 77.8% of cases. Return to work was accelerated by an average of 5 days. At three months, mean PRWE-Fr and QuickDASH scores were 12.9 and 9.42, respectively. Conclusion:Ultrasound is an essential tool in the evaluation and management of acute trauma to the fingers and thumb. It is accessible, easy to perform, and non-irradiating, enhancing the clinical examination by the hand surgeon and enabling early therapeutic adjustments. Level of evidence:Level III.
We report the case of a man in his forties admitted to hospital after being stabbed in the precordial region. The initial chest X-ray and FAST examination revealed nothing abnormal. Despite apparent haemodynamic stability, the patient developed progressive dyspnoea, diaphoresis and signs of circulatory compromise. Due to clinical deterioration, an emergency exploratory thoracotomy was performed. Intraoperative findings revealed haemothorax, haemopericardium, and a perforation of the right atrium associated with pericardial rupture. The cardiac injury was successfully repaired, and the patient recovered favourably. This case demonstrates that initial negative imaging does not rule out significant cardiac injuries in penetrating chest trauma. Careful clinical reassessment and timely surgical intervention remain critical for patient survival.
Posterior hip dislocations with simultaneous femoral head and neck fractures are extremely rare, usually after high-velocity trauma, and demand urgent surgery to prevent complications. A 40-year-old woman sustained a posterior dislocation with femoral head fracture after a low-energy twisting fall. A forceful closed reduction without relaxation caused an iatrogenic femoral neck fracture (Pipkin Type III). She underwent open reduction and internal fixation within six hours of presentation (28 h after injury). Redislocation occurred on day 20 due to unrecognised labral avulsion and acetabular dysplasia, later addressed with labral repair. At two years, she remained pain-free with good functional scores, although the femoral head was not perfectly concentrically reduced on final radiographs, a finding attributed to the underlying dysplasia; she was subsequently lost to follow-up. This case illustrates that good short-term function can be achieved despite imperfect radiographic congruency, while underscoring the importance of recognising dysplasia and labral injury and of considering arthroplasty as an alternative in this fracture pattern.
