The supracondylar humerus fracture (SCHF) in children is common and can be complicated with nerve injury either primarily immediate post-trauma or secondarily posttreatment. The concept of neurapraxic nerve injury makes most surgeons choose to ‘watch and see’ the nerve recovery before deciding second surgery if the nerve does not recover. We report three cases of nerve injury in SCHF, all of which underwent nerve exploration for different reasons. Early reduction in the Casualty is important to release the nerve tension before transferring the patient to the operation room. If close reduction fails, we proceed to explore the nerve together with open reduction of the fracture. In iatrogenic nerve injury, we recommend nerve exploration to determine the surgical procedure that is causing the injury. Primary nerve exploration will allow early assessment of the injured nerve and minimize subsequent surgery.
Radial Nerve ; Ulnar Nerve

Missed Monteggia fracture leading to chronic radial head dislocation is a known complication. The surgical treatment options remain challenging. The aim of treatment is to reduce the radial head and to maintain the stability of the elbow in all ranges of motion. A few surgical techniques have been described with complications. We report the case of a 13 years old boy with chronic radial head dislocation as a result of an unrecognised Monteggia fracture-dislocation for eight years. We successfully reduced the radial head and corrected the cubital valgus from 45 degrees to 10 degrees with a proximal ulna osteotomy and gradual distraction with 2-pin Monotube external fixator. The correction was uneventful with good functional outcome.

Delayed presentation of Developmental Dysplasia of Hip (DDH) comes with challenges in treatment as well as high surgical cost. Therefore the objective of this study is to quantify the economic impact of management of late presentation of DDH during a last 3-year period. We conducted a retrospective study with analysis of DDH cases managed between years 2012 to 2014. Early and late presentations of DDH were identified and cost management for both was estimated. Out of twenty-four DDH cases, thirteen cases fulfilled the inclusion criteria. All were female with majority of them presenting with unilateral DDH predominantly of the left hip. Most patients presented after age of six months and the principal complaint was abnormal or limping gait. The grand total cost for managing DDH during the three years period was USD 12,385.51, with 86% of the amount having been used to manage late presentation of DDH that was mostly contributed by the cost of surgery. We concluded that delayed presentation of DDH contributes heavily to high national expenditure. Early detection of DDH cases with systematic neonatal screening may help to minimize the incidence of the late presenting DDH and subsequently reduce the economic burden to the government.
Bone Diseases, Developmental

Following a week after a jellyfish sting, a young man presented with regional cyanosis and threat of distal gangrene secondary to vascular spasm in the forearm. The patient also suffered from transient paresis and numbness of the affected upper limb. Contrasted imaging revealed unopacified vessels in the distal forearm and worsening swelling warranted emergency surgical fasciotomy for impending compartment syndrome. This case highlights the occurrence of jellyfish envenomation and the need for early treatment.
Wounds and Injuries

Primary sacral tumours are rare, therefore experience of managing their associated complications are very limited. Effective surgical treatment of pelvic chondrosarcoma remains a major challenge for orthopaedic surgeons, due to the complex anatomic structure of the pelvis, the lack of defined compartment borders, the close vicinity to vital structures, and the risk of jeopardizing pelvic structural stability. We report a rare case of a giant sacral chondrosarcoma (100cm x 80cm) in an elderly male who successfully underwent tumour resection with good functional outcome and recovery. Long term follow up is essential in vie
Chondrosarcoma

Postoperative wound infection in an instrumented spine patient is often disastrous. Management includes implant removal leading to spine instability. Negative pressure wound therapy (NPWT) applied to the spine surgical wound is one of the wound care technique with successful results. We report a case of a man who sustained Chance fracture of Lumbar 1 (L1) vertebra treated with long segment posterior instrumentation, who unfortunately developed Extended-spectrum beta-lactamase (ESBL) positive E. coli infection one month after the operation. After careful debridement of the wound, the implant became exposed. Three cycles of NPWT were applied and the wound healed with granulation tissue completely covering the implant, and thus negating the need to remove the implant. In conclusion, the NPWT is a good alternative in postoperative wound management especially in an instrumented spine patient
Negative-Pressure Wound Therapy

Conventional chondrosarcomas rarely metastasize and it is extremely unusual to see multicentric- behaviour in malignant cartilage tumour. We report a 40 year old lady with presentation of two non-contiguous metachronous foci of low to intermediate grade of chondrosarcoma over left pelvic bone and right scalp respectively in the absence of pulmonary or visceral metastasis.
Chondrosarcoma

Shoulder impingement syndrome and acromioclavicular joint osteoarthritis often occur simultaneously and easily missed. Kay et al. reported excellent results with combined arthroscopic subacromial decompression and resection of the distal end of the clavicle in patients with both disorders1 . Arthroscopic treatment of these disorders produces more favourable results than open procedures. We report two patients who were not responding to conservative management and were treated with direct arthroscopic distal clavicle excision and subacromial decompression in single setting. Both patients gained good postoperative outcome in terms of pain score, function and strength improvement assessed objectively with visual analogue score (VAS) and University of California Los Angeles Score (UCLA).
Osteoarthritis