A 15-year-old girl presented with a 2-month history of non-specific right hip pain associated with pain in the back, right flank and foot. Her symptoms deteriorated, interfering with weight-bearing. Following admission, she was found to be febrile with a flexion deformity of her right-hip, and tenderness over the iliac crest and posterior pelvis. A markedly elevated C reactive protein and erythrocyte sedimentation rate, with an ultrasound-proven scan effusion within the right hip were all suggestive of septic arthritis. However, full blood count demonstrated a significant anaemia, which together with the tenderness around the pelvis was not in keeping with this diagnosis. Surgical washout was therefore delayed to obtain a MRI scan of the pelvis. The scan revealed a 5×5×3 cm necrotic soft tissue mass within the gluteal muscles, arising from the right ilium, which biopsy confirmed to be a Ewing's sarcoma.

A 10-year-old boy struck a car bonnet following which his left shoulder got pinned under the wheel. No life-threatening injuries were identified. However, the patient sustained extensive abrasions to the back and the left shoulder, a closed deformity of the left clavicle and a swollen, but stable right knee. The patient was neurovascularly intact globally and all joints had a full range of motion. Plain radiographs suggested a possible greenstick fracture of the left clavicle, but also free gas within the left glenohumeral joint. Concern was raised of an unidentified open injury to the joint. CT was supportive of the finding of gas within the left glenohumeral joint, but ruled out the possible greenstick fracture as a spurious finding. There were no other injuries. The gas was within the left glenohumeral joint and was consistent with vacuum phenomenon. The injury was treated expectantly and the child made a full recovery.

No abstract