Rare Injury Pattern Research Articles

Man on the Mound: Pictures of a Pitcher in Pain.

Description Atraumatic ball thrower's humerus fracture is an uncommon, and poorly understood injury pattern. The majority of these cases are seen in untrained and younger individuals. A missed diagnosis could severely impact a patient's quality of life, as management is operative in most cases. Here, we present the case of a young patient, suffering an atraumatic "ball thrower's" fracture. We present images of this exceedingly rare injury pattern and showcase original artwork with a proposed mechanism of injury.

Patient Characteristics and Postoperative Outcomes of Surgically Treated Inferior Pole Patellar Sleeve Fractures.

Despite representing over half of all pediatric patella fractures, inferior pole patellar sleeve fractures (PSFs) are a relatively uncommon pediatric injury. As a result, existing literature on PSFs is limited to case reports and small case series. The purpose of this study was to evaluate the radiographic and clinical characteristics of operatively treated PSFs as well as outcomes following surgical management. A retrospective review of all inferior pole PSFs requiring surgery from 2007 to 2023 was performed at a single urban tertiary care children's hospital. Cases were identified using diagnostic and billing codes. Patient demographics, injury characteristics, surgical techniques, and postoperative rehabilitation practices were recorded. Regional skeletal maturity, fracture characteristics, and postreduction patellar height were recorded. Postoperative complications were recorded and categorized using the modified Clavien-Dindo Classification System (CDS). Thirty-eight inferior pole PSFs were identified meeting study criteria. The majority of patients were male (86.8%), and the mean age at injury was 11.0 years (range: 7.2 to 15.0). Mean BMI was 21.1. Radiographically, the majority of patients were Epiphyseal Fusion Stage 0 (nonunion), with a median postreduction Caton-Deschamps index (CDI) of 1.2 (IQR: 1.1 to 1.3). These fractures were predominantly treated with suture-based fixation (84%). Postoperative immobilization varied within the cohort, and the initiation of knee ROM was permitted at a median of 3.5 (IQR: 2.0 to 4.6) weeks. All patients regained full range of motion and straight leg raise without extensor lag, and return-to-sport was achieved by a median of 17.6 weeks (IQR: 12.8 to 30.3). Complications occurred in 10 (26.3%) patients, with 3 (7.9%) requiring a return to the OR (CDS Grade III). Inferior pole PSFs appear to occur most commonly among prepubertal males of normal BMI and normal patellar height. Despite variable rehabilitation protocols, operative management resulted in restoration of extensor mechanism function. Eight percent of patients experienced complications requiring unplanned surgery. This large series improves our understanding of the epidemiology, injury characteristics, and postoperative outcomes of an operatively treated cohort of a rare injury pattern. Level IV.

Ipsilateral Supracondylar and Medial Epicondyle Humerus Fractures in Pediatric Patients: A Retrospective Analysis of Incidence, Epidemiology, Treatment, and Outcomes.

Pediatric supracondylar humerus (SCH; AO/OTA13-M/3.1) and medial epicondyle fractures (AO/OTA13u-M/7.1) are common. Concomitant SCH with ipsilateral medial epicondyle fractures remain scarcely reported. We investigated the epidemiology, treatment, and outcomes of this rare, combined injury. A retrospective review of pediatric patients with concomitant SCH and medial epicondyle fractures at a level 1 hospital from 2010 to 2020 was performed. Patient data, treatments, and outcomes were assessed. Radiographs were reviewed for fracture classification and alignment. Patients aged above 18 years and those with inaccessible imaging were excluded. Descriptive statistics were performed. Of 3344 patients undergoing surgery for SCH fractures, 14 (6 females, mean: 10.59y) with concomitant SCH and medial epicondyle fractures were included. Overall, 28.6% of patients exhibited preoperative nerve palsies (3 PIN, 1 median nerve). There was 1 flexion type and 13 Gartland type III SCH fractures. Medial epicondyle fracture displacement averaged 4.13mm (range: 2 to 7mm). Thirteen medial epicondyle fractures occurred medial to the physis with 1 through the physis. Eight patients (57.1%) had medial fixation-7 medial pins, 1 medial screw-which captured both the medial epicondyle and medial column of the SCH fracture. Six medial epicondyles were treated closed. The average time to pin pull was 33.1 days (range: 27 to 51d) with average follow-up of 138.6 days (range: 27 to 574d). Overall, 50% of patients completed physical therapy (PT). Complications occurred in 4 cases: prominence of a medial pin, 1 patient required additional PT and dynamic splinting for loss of functional extension, 1 patient underwent a manipulation under anesthesia 3.5 months postoperatively for flexion contracture, and 1 patient developed medial epicondyle nonunion and SCH malunion that underwent corrective osteotomy 10.5 months postoperatively. Concurrent SCH and medial epicondyle fractures exhibited a high rate of nerve palsy (28.6%) and complications (28.6%) and were frequently referred to physical therapy. While patients treated without medial fixation went on to union, this combined injury might represent a relative indication for medial pinning of the SCH fracture. Further studies on this rare injury pattern are needed to determine optimal treatment methods. Level IV-therapeutic.

Postinfantile Giant Cell Hepatitis in Native and Allograft Livers: A Multi-Institutional Clinicopathologic Study of 70 Cases

Postinfantile giant cell hepatitis (PIGCH) is a rare hepatitis pattern in adults with variable etiologies and clinical outcomes. We conducted a multi-institutional retrospective study to define the clinicopathologic characteristics of patients with PIGCH. A total of 70 PIGCH cases were identified and reviewed for pathological features, including fibrosis, cholestasis, inflammation, steatosis, necrosis, and apoptosis, as well as the distribution of giant cells and the maximum number of giant cells per high-power field. Demographic and clinical data, including age, sex, laboratory results, etiologies, and follow-up results, were recorded. Among the 70 cases, 40% (28/70) were associated with autoimmune liver diseases, followed by 9 (13%) with unknown etiology, 8 (11%) with viral infection, 5 (7%) with medications, 5 with combined etiologies, and 4 (6%) with malignancies (mostly chronic lymphocytic leukemia). Notably, another 16% were de novo PIGCH in liver allografts, most of which occurred after a rejection event. During follow-up, 26 (37%) patients died of the disease and 44 (63%) were alive. Deceased patients were characterized by older age (mean age, 54.9 vs 45.5 years; P = .02), higher alkaline phosphatase level (mean value, 253.3U/L vs 166.3 U/L; P = .03), higher fibrosis stage (stage 3-4 vs stage 0-2, 57.7% vs 29.6%; P = .03), being more likely to have de novo PIGCH after transplantation (23.1% vs 11.4%; P = .04), and being less likely to have primary autoimmune liver disease etiology (26.9% vs 47.7%; P = .04). These results indicate that PIGCH is a rare pattern of liver injury associated with different etiologies and variable clinical outcomes. Autoimmune liver disease with PIGCH is associated with better survival, whereas de novo PIGCH in allografts is associated with poorer survival. Older age, higher alkaline phosphatase level, and advanced fibrosis are adverse prognostic factors.

Pectoralis Major Muscle Belly Rupture in a 17-Year-Old Female Softball Player: A Case Report.

We report the case of a healthy 17-year-old female softball player with a subacute full-thickness intramuscular tear of the pectoralis major (PM) muscle. A successful muscle repair was obtained using a modified Kessler technique. Despite initially being a rare injury pattern, the incidence of PM muscle rupture is likely to increase as interest in sports and weight training increases, and although this injury pattern is more common in men, it is becoming more common in women as well. Furthermore, this case presentation provides support for operative treatment of intramuscular ruptures of the PM muscle.

FLOATING ELBOW: AN INTEGRATIVE LITERATURE REVIEW

Background: Floating elbow is a rare condition caused by ipsilateral humeral and forearm fractures, resulting in an unstable intermediate articulation. High-velocity or high-energy trauma, such as car accidents or high-angle falls, are the main causes of floating elbow injuries. The multiple injuries, open fractures, and neurovascular injury that occur concurrently are the most common. A clinical and radiological diagnosis has been made. Epiphyseal closure and stiffness are problems associated with fractures of the forearm and elbow.
 Objectives: To state the epidemiology of the floating elbow, assess and describe the classification then summarize the management of the injuries of floating elbow.
 Methods: The PubMed database and EBSCO Information Services were utilized to choose the articles. In our review, all pertinent articles related to both our topic and other articles were used. Other articles that have nothing to do with this subject were not included. The group members looked through a certain format in which the data had been extracted.
 Conclusion: Floating elbow is a rare and intricate injury pattern that can result in a variety of functional consequences. The expression describes joint fractures of the humerus and forearm bones in the same extremity. It may affect both adults and children. This damage pattern has been documented in a few published publications, but none of them include epidemiological data, therefore its prevalence remains unknown. Hence, this systemic article state all that helps in knowing the disease.

Neurologic injury after spinopelvic dissociation: Incidence, outcome, and predictors

BackgroundTraumatic spinopelvic dissociation is a rare injury pattern resulting in discontinuity between the spine and bony pelvis. This injury is associated with a known risk of neurologic compromise which can impact the clinical outcome of these patients. We sought to determine incidence and characteristics of neurologic injury, outcomes following treatment, and predictive factors for neurologic recovery. MethodsWe reviewed the clinical documentation and imaging of 270 patients with spinopelvic dissociation from three Level-1 trauma centers treated over a 20-year period. From this cohort, 137 patients fulfilled inclusion criteria with appropriate follow-up. Details surrounding patient presentation, incidence of neurologic injury, and outcome variables were collected for each injury. Neurologic injuries were categorized using the Gibbons criteria. Multivariate analysis was performed to assess for patient and injury factors predictive of neurologic injury and recovery. ResultsThe overall incidence of neurologic injury in spinopelvic dissociation injuries was 33% (45/137), with bowel and/or bladder dysfunction (n=16) being the most common presentation. Complete neurologic recovery was seen in 26 cases (58%) and two patients (4%) improved at least one Gibbon stage in clinical follow-up. The most common long-term neurologic sequela at final follow-up was radiculopathy (n=12, 9%). Increased kyphosis was found to be associated with neurologic injury (p=0.002), while location of transverse limb and Roy-Camille type were not predictive of neurologic injury (p=0.31 and p=0.07, respectively). There were no factors found to be predictive of neurologic recovery in this cohort. ConclusionNeurologic injury is commonly seen in patients with spinopelvic dissociation and complete neurologic recovery was seen in the majority of patients at final follow-up. When present, long term neurologic dysfunction is most commonly characterized by radiculopathy. While increasing kyphosis was shown to be associated with neurologic injury, no patient or injury factors were predictive of neurologic recovery.

A Rare Injury Pattern In The Adult Knee After A Fall

A Rare Injury Pattern In The Adult Knee After A Fall

948 Traumatic Native Hip Dislocation Without Associated Fracture: A Case Series of 13 Patients Over 9 Years

Abstract Aim Traumatic native hip dislocation (NHD) is rarely without an associated fracture or due to low energy trauma. Posterior dislocation is the most common pattern of hip dislocation. In most cases, closed reduction is successful, but occasionally open reduction is required to achieve appropriate reduction. The aim of our study was to present the 9-year experience from our institution of this rare injury pattern and to comment on how our experience correlates with the current literature. Method This is a retrospective case series of all adult patients (> 16 years old) with a traumatic NHD without fracture presented and/or treated at our institution, between the 1st of January 2012 and 22nd June 2021. Results Thirteen cases of traumatic NHD were identified (38.4% female). The mean age was 26.5 years. Typically, younger patients were involved in lower energy injuries. The direction of hip dislocation was posterior in 10 cases. Associated injuries were seen in 3 patients. 12 cases underwent successful closed reduction, and 1 case was operatively managed. 3 cases had a previous hip pathology including femoroacetabular impingement, cam lesion and childhood slipped upper femoral epiphysis. Conclusions Traumatic NHD without associated fracture is a rare injury pattern, most commonly occurring in patients under the age of thirty. A target of 6 hours for reduction should be employed as this will reduce the risk of AVN in those who have not permanently damaged the vessels at the time of injury.

Arthroscopic Dorsal Ligamentocapsulodesis in the Management of Combined Tears of Scapholunate and Lunotriquetral Ligaments: Surgical Technique and Preliminary Clinical Results.

Introduction The literature is scarce regarding the management of combined tears of scapholunate (SL) and lunotriquetral (LT) ligaments. This study aimed to evaluate our preliminary results with the arthroscopic dorsal ligamentocapsulodesis in managing such cases. Materials and Methods Forty-two patients (13 females, 29 males; mean age = 31; age range = 18-51 years) who underwent arthroscopic dorsal ligamentocapsulodesis due to the combined tears of SL and LT ligaments were retrospectively reviewed. The mean follow-up was 38 (range = 24-55) months. The Modified Mayo Wrist Score, the visual analogue scale (VAS), and grip strength were assessed preoperatively and at the final follow-up examination. Results The mean Modified Mayo Wrist Score significantly improved from 49 (range = 25-70) preoperatively to 82 (range = 60-100) at the final follow-up ( p = 0.000). The mean VAS significantly decreased from 6.33 to 1.6 ( p = 0.000). The mean hand grip strength significantly improved from 31 (range = 19-41) kg to 44 (range = 25-60) kg at the final follow-up examination ( p < 0.001). No major complications were encountered. Conclusion Arthroscopic dorsal ligamentocapsulodesis seems to be a safe and effective surgical technique in the management of this rare combined injury pattern. Level of Evidence This is a Level IV, retrospective case series study.

Vacuolar tubular injury after exposure to immune check-point inhibitor

Renal toxicities have been increasingly recognized as complications of immune checkpoint inhibitor therapy. These drugs are associated with a broad range of immune-related adverse events in the kidney, including interstitial nephritis, glomerulonephritis, and acute tubular necrosis. We describe a woman with a rare pattern of injury, osmotic tubulopathy, after exposure to pembrolizumab that has been described only once before in the medical literature. As a result of these observations, vacuolar tubular injury pattern that has the appearance of an osmotic lesion should be considered as a possible consequence of immune checkpoint inhibitor therapy.

Concomitant bilateral medial malleolus stress fracture: a case report and review of literature of an extremely rare injury

&lt;p&gt;Medial malleolus stress fractures are rare stress injuries and account for 4% of all the stress fractures. Bilateral medial malleolus stress fracture (MMSFs) is extremely rare with only five such cases reported in existing literature. We report an extremely rare injury pattern in the form of concomitant bilateral MMSF in a young military recruit who presented with severe pain in both his ankles for one month.&lt;strong&gt; &lt;/strong&gt;A 20-year military recruit undergoing rigorous physical training presented to us with severe bilateral ankle pain of one month duration. Clinico-radiological examination revealed bilateral MMSFs. He was managed with open reduction and internal fixation using a one-third tubular plate in buttress mode. Patient was gradually rehabilitated and on one-year follow up, he is asymptomatic and performing all strenuous physical activities. Bilateral MMSFs are extremely rare injuries with only five such cases reported in existing medical literature and this is the fourth instance where bilateral MMSFs were diagnosed at the time of clinical presentation and managed simultaneously, in the same surgical setting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt; &lt;/strong&gt;&lt;/p&gt;

Characteristics and outcomes of glomerulonephritis with membranoproliferative pattern in children.

BackgroundMembranoproliferative glomerulonephritis (MPGN) is a rare histopathologic pattern of glomerular injury with limited studies in pediatric patients. Characteristics and outcomes of children with MPGN have also remained to be further explored.MethodsWe retrospectively reviewed the clinicopathological features, genetic findings, treatments and outcomes in 17 pediatric patients pathologically diagnosed with MPGN from 2007 to 2020 in the Children’s National Medical Center in China.ResultsMedian age at disease onset was 9.9 years (IQR, 5.6–11.9 years). Most of the patients (12/17) had nephrotic range of proteinuria, and nephritic-nephrotic syndrome was the most common clinical presentation (35.2%). Secondary causes were identified in eight patients including hepatitis B virus (HBV) infection (n=4), methylmalonic acidemia (MMA, n=2), rheumatoid arthritis (RA, n=1) and Aymé-Gripp Syndrome (n=1). The nine patients with primary MPGN were further identified as immune-complex mediated MPGN (n=8), and unclassifiable MPGN (U-MGPN, n=1). Genetic analyses identified pathogenic variants of MMACHC gene in two cases of MMA and established the diagnosis for Aymé-Gripp syndrome in one case with a de novo variant of MAF gene. Comparing study between the complete or partial remission group (n=8) and non-response group (n=9) showed a significant difference in the timing of renal biopsy (P<0.05). Normal renal function was preserved in ten patients at the last follow-up. Two patients developed into end-stage renal disease (ESRD).ConclusionsChildren with MPGN pattern present heterogenous clinical features. Genetic detection helps to explore underlying causes of MPGN. Early identification of the primary or secondary causes of MPGN in children is vital.

ACUTE FIBRINOUS ORGANIZING PNEUMONIA: A NEW ASSOCIATION

TOPIC: Lung Pathology TYPE: Fellow Case Reports INTRODUCTION: Acute Fibrinous and Organizing Pneumonia (AFOP) is a rare histological pattern of acute lung injury of unclear etiology. It can present with severe hypoxemia and characteristic bilateral basilar infiltrates meeting criteria for acute respiratory distress syndrome(ARDS). We present the case of a 48-year-old female with ARDS who was diagnosed with AFOP after an open lung biopsy. CASE PRESENTATION: A 48-year-old female with a past history of schizophrenia, hypertension, type 2 diabetes, osteoarthritis and monoclonal gammopathy of undetermined significance (MGUS) presented with cough and progressive shortness of breath, worsening acutely over three days. Upon arrival, the patient was hypoxic with oxygen saturation of 47%, on room air so she was emergently intubated. Initial chest X-ray revealed bilateral mid to lower zone infiltrates concerning for severe pneumonia (Picture 1). Chest CT-Angiogram ruled out pulmonary embolism. She was admitted to our intensive care unit and started on empiric broad spectrum antibiotics (Vancomycin/Piperacillin-Tazobactam/Levaquin) and ventilated using a lung-protective strategy for ARDS. Over the next 15 days, she remained ventilator dependent with high FiO2/PEEP requirements and eventually had a tracheostomy. Microbiological studies including bronchoscopic samples remained negative. An open lung biopsy was performed which showed lymphocyte and plasma cell infiltration and intra-alveolar fibrin balls with an absence of neutrophil/eosinophil infiltration and hyaline membrane formation typical of other well-recognized patterns of acute lung injury, leading to a diagnosis of AFOP (Picture 2). She was started on high dose steroids (methyprednisolone 60mg IV q8h) with prompt resolution of infiltrates and improvement in her oxygenation. DISCUSSION: (AFOP) is a rare histologic pattern of acute lung injury with multiple clinical associations but unclear etiology. Two clinical patterns have been described: i) an acute fulminant condition with severe hypoxemia and ii) a subacute respiratory illness. Diagnosis requires biopsy revealing intra-alveolar fibrin balls amidst an organizing pneumonia. AFOP has been described in patients with HIV infection, decitabine exposure, amiodarone toxicity, post hematopoietic stem cell transplantation, connective tissue diseases etc. Patients have been treated with corticosteroids, mycophenolate mofetil, cyclophosphamide, and cyclosporine with variable response. [1] CONCLUSIONS: In this case, monoclonal gammopathy of unknown significance (MGUS) represents a new association of AFOP and thus adds to our understanding of the clinical and pathological characteristics of this disease. REFERENCE #1: 1. Acute fibrinous and organizing pneumonia and undifferentiated connective tissue disease: a case report. Valim V, Rocha RH, Couto RB, Paixão TS, Serrano EV. Case Rep Rheumatol. 2012;2012:549298. doi: 10.1155/2012/549298. Epub 2012 Apr 4. DISCLOSURES: No relevant relationships by Sukhmani Boparai, source=Web Response No relevant relationships by Prangthip Charoenpong, source=Web Response No relevant relationships by Deon Ford, source=Web Response

Transmediastinal penetrating trauma.

Penetrating transmediastinal injury (TMI) is associated with a high mortality rate and presents a challenging diagnostic scenario. Previous dogma mandated surgical exploration or extensive and invasive investigations for all patients sustaining transmediastinal penetrating trauma, regardless of hemodynamic status. Since the late 1990s, the paradigm has changed, with most centers adopting a tiered approach to management based on clinical presentation. Transmediastinal penetrating trauma is a rare injury pattern and can result from gunshot wounds, stab wounds, blast injuries, and other missiles. The most predominant source, however, remains gunshot wounds, accounting for the vast majority of these injuries. A systematic approach in the emergency department to diagnosis and management should be undertaken and patients in extremis or with hemodynamic compromise rapidly identified. The unstable patient forgoes further investigations and the surgeon must use knowledge about the hypothesized trajectory, results of limited imaging, chest tube output, and anticipation of resuscitative maneuvers to select the best operative approach. In patients who are sufficiently stable to undergo CT angiogram (CTA) of the chest, the trajectory of the missile or impalement can often be deduced and this is used to guide further investigation or operation. In those where ambiguity remains, more focused tests such as echocardiography, pericardial window, esophagoscopy or esophagography, and bronchoscopy can be used to assess the mediastinal structures. For the stable patient, management proceeds with cautious and expeditious investigations to determine the extent of underlying organ-specific injuries. Thus, in patients with this injury pattern, determination of the patient’s clinical status is critical to determine the appropriate course of management.

Concomitant Pediatric Burns and Craniomaxillofacial Trauma.

This study is the first to investigate pediatric craniomaxillofacial (CMF) trauma patients that present with concomitant burns. The authors aim to identify differing etiologies, presentations, facial fracture patterns, interventions, and outcomes between pediatric CMF trauma patients with versus without concomitant burns. In this retrospective cohort study of a tertiary care center between the years 1990 and 2010, concomitant burns were identified among pediatric patients presenting with CMF fractures. Patient charts were reviewed for demographics, presentation, burn characteristics (total body surface area %, location, and degree), imaging, interventions, involvement of child protective services, and long-term outcomes. Data were analyzed using two-tailed Student t tests and chi-square analysis. Of the identified 2966 pediatric CMF trauma patients (64.0% boys; age 7 ± 4.7 years), 10 (0.34%) patients presented with concomitant burns. Concomitant burn and CMF traumas were more likely to be due to penetrating injuries (P < 0.0001) and had longer hospital lengths of stay (13 ± 18.6 versus 4 ± 6.2 days, P < 0.0001). 40% were due to child abuse, 40% due to motor vehicle collisions, and 20% due to house fires. All four child abuse patients presented in a delayed fashion; operative burn care was prioritized and 70% of the CMF fractures were managed nonoperatively. Concomitant burn and CMF trauma is a rare injury pattern in pediatrics and warrants skeletal surveys with suspicious injury patterns. Future research is necessary to develop practice guidelines.

Bilateral Posterior Temporal Lobe Contusions as a Rare Pattern of Traumatic Brain Injury.

A 56-year-old woman was found hypothermic on her bathroom floor with a scalp wound, with laboratory results indicating long lie. She was lethargic and had difficulties finding words. CT scan revealed symmetric posterior temporal lobe hypodensities with punctiform hemorrhagic transformation (figure). Radiologic differential diagnosis included encephalitis,1 but CSF showed normal cytosis, xanthochromia, and elevated protein. Contusions are the most common intra-axial injuries, caused by sudden deceleration and impact of the brain against bone or dura mater.2 In this case, the impact occurred symmetrically against the tentorium cerebelli, presumably caused by a fall straight on the vertex while the patient was exiting the bathtub.

602 Concomitant Pediatric Burns and Craniomaxillofacial Trauma: A Pediatric Burn Center’s Experience over 20 Years

Abstract Introduction Recent progress in pediatric burn care has reduced the mortality rate by 48.1% (Armstrong, 2020). Although it is well understood that mortality increases with increased number of systems involved, prior studies have not documented the effect of concomitant pediatric burn and craniomaxillofacial (CMF) trauma in pediatric patients. This retrospective cohort study is the first known to characterize presentation, management, and long-term outcomes of concomitant burns with CMF trauma in pediatric patients. Methods We performed a retrospective cohort study of all pediatrics patients who presented at a tertiary care center between the years 1990 to 2010 with CMF fractures and burns. Patient charts were reviewed for demographics, mechanism of injury, burn characteristics (TBSA %, location, and degree), imaging and interventions, involvement of child protective services, and long-term outcome. Data was analyzed using two-tailed Student’s t tests and chi square analysis. Results Of the 2,966 pediatric CMF trauma patients (64.0% boys; average age 7 ±4.7 years) that were identified, a total of 10 (0.34%) patients were identified to have concomitant burn injuries. Patients with concomitant burn and CMF injuries were less likely to have sustained blunt injuries (P &amp;lt; 0.0001) and had longer hospital lengths of stay (13 □ 18.6 vs 4 □ 6.2 days, P &amp;lt; 0.0001). Approximately 60% of CMF fractures were upper-third injuries. The CMF fractures of all 10 cases (100%) were managed non-operatively. 40% were due to child abuse, 40% due to motor vehicle collisions, and 20% due to house fires. Of the four patients who presented due to child abuse, CMF trauma was incidentally found on imaging. One (13 months, female) child-abuse case was found to have 32% TBSA 2nd and 3rd degree burns to bilateral lower extremities after being submerged in hot bathwater and had concomitant orbit/skull fractures. Two other child abuse cases presented with hand burns and concomitant nasal/skull fractures. All four child abuse patients presented in a delayed fashion. Conclusions Concomitant burns and CMF trauma is rare injury pattern in pediatric populations and is associated with longer hospital lengths of stay. Child abuse and motor vehicle accidents caused 80% of the cases.

POSTEROMEDIAL ELBOW DISLOCATION WITH IPSILATERAL DISTAL RADIUS FRACTURE

Distal radius fractures with concomitant ipsilateral elbow dislocation are a rare injury pattern. Only a few cases of a distal radius fracture with ipsilateral elbow dislocation have been reported. We discuss the case of a 46-year-old gentleman presenting with posteromedial elbow dislocation with an ipsilateral closed extra-articular fracture of the distal radius. Plain radiographs showed a right posterior-medial elbow dislocation and ipsilateral distal radius fracture. CT scans of the elbow showed impaction fractures of the coronoid and trochlea, suggesting a concomitant posteromedial varus elbow dislocation injury. CT scans of the wrist showed the presence of a comminuted, extra-articular distal radius fracture. Surgical fixation of the distal radius was performed, as well as repair of the right elbow lateral capsule-ligamentous complex with suture anchors. Proper recognition of the posteromedial varus instability type injury to the elbow, as in this case is important, should be addressed. If VPMRI is missed, it can lead to ulno-humeral osteoarthritis of the elbow joint.

Management of a Lateral Meniscus Tear with Bucket-Handle Displacement in a Seven-Year-Old with Lateral Discoid Meniscus Morphology: A Case Report

Background: Lateral meniscus tears in patients less than ten years old are exceedingly rare. Displaced bucket handle tears of the lateral meniscus are even less commonly encountered. Hypothesis/Purpose: This case report details the presentation, treatment, and recovery of a seven year old female who presented with a bucket handle lateral meniscus tear and was found to have underlying discoid meniscus morphology. Methods: This case report details the pre-operative, arthroscopic findings, repair technique, and post-operative outcome of a single patient presenting with a rare injury pattern. Results: The lateral meniscus was torn along the periphery at the meniscocapsular junction involving zones I-III with displacement into the notch. The meniscal tissue appeared hypertrophied and was noted to be a Wrisberg type discoid variant. A saucerization and repair was performed using sutures utilizing a combination of all-inside and outside-in repair techniques. The patient regained full range of motion and returned to full unimpeded activity at three months post-operatively. Conclusions: This is a unique case of a pediatric patient less than ten years old presenting with a bucket-handle tear of a discoid lateral meniscus who underwent surgical repair. The case details the saucerization and repair technique with successful recovery of this pediatric patient to date. It highlights a technique for meniscus repair in lieu of partial meniscectomy which is of particular benefit in the pediatric population.