High-energy ESWT appears to be effective and safe in patients for treatment of nonunion or a delayed healing of a proximal metatarsal, and in fifth metatarsal fractures in Zone 2.

Here, we present a rare case of metastatic methicillin sensitive infection arising from an unknown focus and spreading throughout the lumbar spine with associated pyomyositis of the paraspinal musculature, and septic arthritis of the knee, ankle and sternoclavicular joint. This case highlights the potential for missed aspects and delay in diagnosis in the care of metastatic and the need for multispecialty intervention. Treatment of infections requires a high index of suspicion and careful examination of multiple organ systems to identify the full extent of the disease. A discussion on metastatic infection follows the report.

Acetabular fractures are injuries that require significant force transmission, especially when associated with a femoral head dislocation. The mechanism of injury is typically in the setting of a high-speed motor vehicle collision. In a similar manner, this is an injury that is highly demanding for the orthopaedic trauma surgeon to treat as well. We present a patient who sustained an initial posterior wall acetabular fracture with an associated posterior dislocation. This was treated surgically with open reduction, internal fixation without complication. The patient subsequently sustained a second posterior wall acetabular fracture with dislocation fifteen years later through the plated and healed previous fracture. Both injuries were sustained in high-speed motor vehicle collisions, so it is difficult to presume the patient was predisposed for the repeat injury. At any rate, the repeat injury makes the surgical management significantly more challenging. In complicated acetabular fractures like these, a post or intra-operative CT scan can be of utility to determine quality of reduction as well as assessing for retained bony fragments. Our patient underwent a post-operative CT scan with the finding of intra-articular bony fragments that subsequently required arthroscopic removal. Given the rare nature of this complicated injury occurring twice in a patient, it is difficult to make evidence-based comments on long-term prognosis and functional outcomes. This unique case and the applied treatment will serve as a guide for future similar cases.