Background and purposeHemo-lymphangiomas are rare benign tumors that arise from congenital malformation of the vascular system. They are usually diagnosed at birth or early in childhood. The management of hemo-lymphangiomas in children remains challenging because complete resection is often difficult to be achieved and recurrences are common.MethodsWe present the case of two children with a mass on their left tibia. Imaging modalities, plain radiograph, Ultrasonography and Magnetic Resonance were used to investigate the nature of the mass, the anatomical relationship to the neighboring tissues and help planning the surgical resection. The dominant diagnosis was hemo-lymphangioma. Both lesions increased in size in a short period of follow-up thus we decided to proceed to surgical excision.The diagnosis of hemo-lymphangioma was confirmed by histological examination of the surgical specimen.Post-operatively, seroma was formed to the first patient, managed by placing a drainage and immobilizing the limb on a splint.The second patient experienced no complications post-operatively.After 12 months of follow-up both patients had no complications or recurrence.ConclusionsVery few cases of hemo-lymphangiomas of the extremities have been reported in the literature. Those tumors can grow slowly and remain asymptomatic for a long period of time or may become aggressive and enlarge rapidly, without invasive ability though.Radical resection is the choice of treatment offering the lowest recurrence rates. Other therapeutic methods are: aspiration and drainage, cryotherapy, injection of sclerotic agents and radiotherapy; although none of those offers better results that the surgical excision.

Congenital insensitivity to pain with anhidrosis is a type IV hereditary sensory and autonomic neuropathy, presenting early in life. This disorder results from defective neural crest differentiation with loss of the first-order afferent system, which is responsible for sensations of pain and temperature; a neuronal loss in the sympathetic ganglia is also present. A case of a 33-year-old patient with congenital insensitivity to pain with anhidrosis is presented. From the time of birth, he did not sweat and did not respond to painful stimuli, although unexplained bouts of fever were often observed in infancy; an extensive workup during childhood helped establish the diagnosis. Throughout childhood and adulthood, the patient presented multiple infections and fractures in various sites of his body, growth disturbances, and avascular necrosis, and Charcot arthropathies and joint dislocations mainly affected his elbow and hip joint. At the final follow-up, at the age of 33 years, he was found to be obese, with a limited social life. A Charcot elbow restricted the activity of his left upper limb, and the dislocated hips combined with the instability of the ankle joints limited the ambulation distance. A specific treatment protocol has not been established in the literature; the main principles that can be applied in patients with normal intelligence include training programs to prevent self-mutilation and accidental injuries and an early diagnosis and treatment of the infections.

Introduction: The National Institute for Health and Care Excellence (NICE) in 2011 declared standards in the management of fracture neck of femur (NOF) patients suggesting a total hip replacement (THR) if necessary criteria were met. The Best Practice Tariff (BPT) states all NOF fracture patients should be operated on within 36 h of presentation to Accident & Emergency. We conducted this retrospective study for the years 2016–2018 to evaluate the adherence to these guidelines by Basildon and Thurrock University Hospital and compared the results with national standards. Methods: Data for the period from 2016 to 2018 was collected from the National Hip Fracture Database (NHFD) retrospectively. The data was analysed to calculate various procedures performed for fracture NOF fixations, the number of THR’s for displaced intracapsular fracture NOF, and percentage of patients operated within 36 h and evaluated reasons for the delay. Results: Over the 3 years, the number of THR eligible displaced intracapsular neck of femur fracture patients that underwent THR was above the national average. Across all 3 years, the number of patients who underwent surgery within 36 h was less than the national average. Administrative/logistic reasons for the delay were the major cause for delayed surgery in all 3 years. Conclusion: Compliance with the NICE guidelines and achievement of national standards in NOF fracture care is achievable by most district general hospitals. Awareness and implementation of NICE guidelines for THRs need to be enhanced. A sustained, continual team effort and strict vigilance are necessary to prevent delayed surgery.

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This study aims to review anatomical restoration of glenoid version and humeral head centring in anatomic total shoulder replacements (ATS) in B2 glenoids using CT scans.Background: Uncorrected retroversion in B2 glenoid causes eccentric loading and failure of the glenoid component in TSA. It also leads to humeral head decentring with posterior rim loading, early glenoid wear and component loosening.Methods: This is a retrospective review of TSA for glenohumeral osteoarthritis with B2 glenoid morphology. All polyethylene posterior wedge augmented glenoid component (Tornier Aequalis Perform Plus, TN, USA) was used. Patients underwent pre and post operative CT scans. Glenoid version was calculated using neoglenoid line and medial scapula border as reference point. This was done at mid-glenoid height on axial CT-scan with best-fit ellipse method. Pre and Post-operative humeral head centering was calculated using offset of centre of humeral head with plane of scapula on axial CT-Scan. During surgery, eccentric reamer with depth stop on paleoglenoid was used to ream neoglenoid to accept posterior wedge augment.Results: Ten patients with 11 TSA were recruited between June 2017 and July 2018. Mean age was 59 (45-80) years with 5 females and 5 males (one patient had bilateral arthroplasty). Average follow-up interval between CT scan and surgery was 11 months. Mean preoperative retroversion was 16(13-23) degrees. This was corrected to a mean of 0 degrees retroversion postoperatively, ranging from 8 degrees of anteversion to 3 degrees of retroversion. All patients achieved retroversion less than 5 degrees. Hence, 63% had good radiological correction (0-5 degrees retroversion). Mean pre-operative humeral head scapula offset was 9.7mm (13.7-2.9mm). Humeral head was well centred post-operatively with mean humeral scapula alignment offset of 2.1(0.8e4.5) mm posteriorly. All the cases had well-centered humeral head postoperatively with offset less than 5 mm.Conclusions: Total shoulder replacement in B2 glenoid is technically demanding. Our radiological results show favourable outcome in terms of correction of glenoid retroversion and eliminating posterior instability using wedge glenoid component.