Introduction This observational study investigated the incidence of distal radius fractures in children, to determine whether the rate is rising, the effect of seasonal variation on incidence and whether fracture type and rate of surgical intervention has changed, to help in determining costs for secondary care and to aid resource allocation. Materials and methods All paediatric patients(n = 6529) who sustained a distal radius fracture over an eight-year period (2007–2014) were identified. Poisson regression modelling was used to identify change in trends. Results There was no change in distal radius fracture incidence, rate of surgical intervention (P = 0.36) or fracture type (P = 0.70). Overall incidence was 337 fractures per 100,000 patient/years. The highest fracture incidence was seen in older school boys (708 per 100,000 patient/years, P < 0.005). Overall fracture rate was lower in winter (P < 0.005). Incidence is highest in summer and the main variation is related to season. Discussion These data can help to predict accurately the number of children presenting to the emergency department with wrist fractures depending on the time of year.

Acute compartment syndrome is a surgical emergency that most commonly occurs after trauma or reperfusion after prolonged arterial occlusion. It is caused by a build-up of blood and oedema fluid within a closed muscle compartment, and can be limb and life-threatening. It is therefore imperative that a prompt diagnosis is made. The risk of developing this condition is <1% in patients with distal radius fractures and 4-5% in those with tibial diaphyseal fractures. Pain management is an important aspect of treatment following any fracture. Regional anaesthesia can be used during surgical fixation of the fracture and has the potential to reduce the need for specialist postoperative care and analgesia, as well as to shorten the length of hospitalisation. With this case report, we hope to highlight the potential risk of masking symptoms of compartment syndrome while using regional blocks, as this can cause a delay in diagnosis and treatment, leading to associated complications.

Sarcomatoid renal cell carcinoma (SRCC) is a highly aggressive form of dedifferentiated renal cell carcinoma. We report a 65-year-old man who presented to the emergency department with respiratory symptoms, obstructive jaundice with deranged liver function tests and raised inflammatory marker. General physical examination showed a swelling in left supraclavicular region. The initial differential diagnosis was pancreatic cancer, bronchogenic carcinoma, gastric cancer and lymphoma. Computer tomography (CT) scan showed a solid right renal lesion, multiple liver metastases, florid chest, lymphadenopathy in left supraclavicular region and a right adrenal mass. Patient had biopsy of left supraclavicular node which diagnosed it as a metastatic high grade sarcomatoid renal cell carcinoma. We present the findings and a brief review.