We report a case of femoral nerve palsy occurring as a result of spontaneous bilateral iliopsoas haematomas in an elderly patient on treatment dose dalteparin for a suspected pulmonary embolus. There are limited case reports in the literature relating to this rare problem, and their management is controversial. We advocate non-operative treatment in the instance of a delayed presentation in a frail elderly patient with a subsequent good functional outcome.

The purpose of this study was to assess orthopaedic litigation in the NHS over 10 years (2000–2010) looking at the financial loss, injuries (negligence) sustained and causation that resulted in these successfully litigated cases. By doing this we analyse the financial burden, assessing whether the situation is improving, and also learn valuable lessons on improving care. The study included all cases that involved orthopaedic litigation within English NHS hospitals, for patients over the age of 16. Litigation is actually relatively uncommon within the NHS in England with 0.07% claims for the total number of consultant episodes over 10 years. However, it still remains costly at £251 million. Recent trends demonstrate promising results with a reduced number of claims, and more successfully defended closed claims which may be a reflection of subspecialisation within orthopaedics. However, spinal themes relating to delayed diagnosis and negligent surgery account for the 40 of the claims within the top 100 pay outs. Reducing litigation is vital in order to retain autonomy within the profession and can be helped by documenting what you did; the reasoning behind any decision you made; and what your notes say.

Sporadic Creutzfeld-Jakob disease (CJD) is a rare neurodegenerative disorder. It is uniformly fatal. Clinical signs include myoclonus, visual disturbances, cerebellar ataxia, akinetic mutism and pyramidal/extrapyramidal signs in addition to a rapidly progressive dementia. Premortem diagnosis is challenging due to the rarity of the condition and the subsequent low index of suspicion held for it. On literature review, isolated language impairment as the first neurological symptom occurs in only about 1% of patients with sporadic CJD (El Tawil et al. (2017, Acta Neurol Scand, 135: 316–23)). We present this patient’s case, marked for the unusual presentation and the rapidity of decline, to emphasise the need for awareness of CJD as an important differential diagnosis on stroke units. In our case, magnetic resonance imaging findings drove the suspicion of sporadic CJD as the diagnosis. This seems to correlate with other case reports recognising CJD presenting with progressive aphasic disorders (Terrin et al. (2017, Neurol Sci, 38: 1535–7); Mandell et al. (1989, Neurology, 39: 55–8); Martory et al. (2012, Eur Neurol, 67: 360–2)).