Case: We present the case of a 31-year-old man who sustained simultaneous displaced anterior and posterior cruciate ligament (PCL) tibial avulsion fractures after falling from a bicycle. Conclusion: Combined avulsion fractures of the anterior and PCLs is an extremely unusual event and has rarely been reported. The displaced fragments pulled proximally by their respective cruciate ligaments required open reduction and internal fixation to prevent impingement and instability. The patient had excellent clinical and radiographic results after open reduction internal fixation of both fractures.

We present the case of a 38-year-old man who presented 7 years after primary total hip replacement with a fracture of the neck of a lateral flare femoral stem and catastrophic polyethylene wear. The unique design of the lateral flare hip stem has been shown previously to be associated with accelerated polyethylene wear, whereas the stem remains well fixed. The resultant polyethylene wear results in the harder cobalt chrome head abrading the titanium shell generating metallic debris. This may have resulted in proximal migration of the implant neck into the cup with subsequent neck-cup impingement and implant fracture.

CASE:A 51-year-old male construction worker with a history of chronic quadriceps tendon rupture presented with no active knee extension and tricompartmental knee osteoarthritis. He underwent simultaneous total knee arthroplasty and extensor mechanism allograft reconstruction. At 4 years postoperatively, the patient had pain-free knee function and active extension.CONCLUSION:The combination of a chronic quadriceps tendon rupture with lack of active knee extension and knee osteoarthritis is a rare and challenging problem. To our knowledge, this combined diagnosis and the treatment described in this case report have not been reported previously in the literature.

Inflammatory complications after routine vaccination, including pain, local erythema, and bursitis, have been reported. Several cases of bursitis after vaccination, most commonly with the pneumococcal and influenza vaccines, have been reported in the literature [1–8]. Many of these cases have been attributed to poor technique of the administrator or an inflammatory reaction when the vaccine is deposited in the subdeltoid space [1, 3, 7]. Many of these reactions are self-limiting and demonstrate good relief with subacromial corticosteroid injection [1–4, 7]. We report a case of a patient who rapidly developed a septic shoulder joint after pneumococcal vaccination in her right deltoid. This required prompt surgical shoulder arthrotomy, irrigation, and debridement.

"Floating elbow" injuries of the arm traditionally represent a combination of humeral shaft and forearm fractures which require anatomic rigid open reduction and internal fixation of all fractures to allow for early range of motion exercises of the elbow. There are published variants of the floating elbow injury which include ipsilateral diaphyseal humeral fracture, proximal ulna fracture with proximal radioulnar joint disruption, and ipsilateral diaphyseal humeral fracture with elbow dislocation and both bones forearm fracture. We present the case of a 21-year-old woman whose left arm became caught between the side of a waterslide and adjacent rocks at a park. She sustained a torsional and axial loading injury to her left upper extremity resulting in ipsilateral humeral shaft and Galeazzi fractures. The combination of ipsilateral humeral shaft and Galeazzi fractures resulted in a rare floating elbow variant. Prompt open reduction and internal fixation of both fractures and early range of motion of the elbow and wrist resulted in an excellent clinical and radiographic result. Floating elbow injuries and their variants should be promptly recognized as early anatomic reduction, and rigid internal fixation can allow for good elbow function with minimization of stiffness.

* U-type or H-type sacral fractures are a result of very high energy injuries that separate the lumbar spine and upper sacrum from the lower sacrum and pelvis. Advances in acute trauma care have resulted in an increase in the number of patients who survive this injury. * The choice of approach is dictated by several factors, including dorsal soft-tissue trauma, the need for neurological decompression, and the adequacy of sacral sagittal balance. * Complication rates following surgical treatment are high and primarily are related to the soft tissues. * This fracture pattern has a high association with polytrauma, major neurological injury (including cauda equina syndrome), and soft-tissue degloving injuries. * While nonoperative management may be appropriate for patients who are expected to be bedbound or non-weight-bearing for at least 3 months, the majority of these injuries are treated surgically with iliosacral screws and spinal constructs that anchor the pelvis to the lower lumbar spine. * Careful attention to damage-control principles, efficient surgical stabilization of the spondylopelvic injury and associated fractures, and early mobilization can lead to good functional outcomes following this potentially devastating injury.

The projected increase in the number of primary total hip and knee arthroplasties is expected to result in a major revision burden over the next decade. A major cause of this revision burden is failed joint arthroplasty secondary to infection. There are several preoperative, intraoperative, and postoperative factors that can contribute to the development of deep periprosthetic joint infection. Many of the preoperative factors involve appropriate patient selection. Intraoperative factors are directly related to the performance of the operation. Postoperative factors involve management of indwelling catheters, anticoagulation, and prolonged wound drainage. Identification of these specific risk factors for deep periprosthetic infection and employment of appropriate evidence-based interventions to mitigate these risks can reduce the failure rate of primary hip and knee arthroplasty and can decrease patient morbidity.