Introduction Popliteal artery (PA) injury is an emergency that has a high limb threat potential. Methodology This is a retrospective study of those with documented PA injuries in bed head tickets among those presenting with arterial injuries to the Teaching Hospital, Anuradhapura (THA) from January 2017 to June 2019. Demography, anatomical details of injury, concomitant injuries, type of surgical intervention and perioperative outcomes were assessed. Results Twenty case records were studied. Eighteen (90%) were males, with a mean age of 38.7 years (18-69). Eight (40%) were following motorcycle accidents and 7 (35%) were trap gun injuries. Median ischemic time was 9.5 hours (3-29). Seventeen (85%) had associated fracture or dislocation (p0.003). Four (20%) had associated venous injury. Seven arteries (35%) were contused, 6 (30%) were lacerated. Eleven (55%) underwent reversed saphenous vein graft repair, end to end anastomosis was done in 1 (5%) and ligation was done in 2 (10%). None of the patients underwent fasciotomy at the hospital where they were admitted first. Nine of fourteen patients (64.3%) had all compartments viable on fasciotomy. Two (10%) patients following trap gun injury who also had associated venous injury underwent amputation. Concomitant venous injury had a significant association with amputation rate (p 0.0316) Conclusion Motorcycle accidents and trap guns were the leading cause of PA injury. PA injury was significantly associated with fractures around the knee joint. Concomitant popliteal venous injury, which is common after trap gun injury, had significant association with poor outcome.

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When considering tumors of the bone, metastatic disease from a distant primary is more common than primary tumors of the bone itself. The commonest sites to which skeletal metastasis occur are in the axial skeleton, and with regard to the appendicular skeleton, metastasis to the forearm bones is uncommon. Almost a third of patients who present with skeletal metastases do not have any evidence of their primary tumor at presentation. We report a case of a 68-year-old female diagnosed with lung adenocarcinoma after presenting with metastatic deposits involving the right radius as the first clinical manifestation of her disease. She presented initially complaining of painful swelling of her right forearm for a duration of one year. Imaging investigations of her right forearm showed an expansile mixed lytic and sclerotic lesion involving the full length of the right radius. A contrast-enhanced computed tomography scan of her chest to investigate the possible site of primary malignancy showed a peripherally located, well-defined, irregularly shaped mass lesion with enlarged mediastinal lymph nodes. A fluorodeoxyglucose positron emission tomography (FDG-PET) bone scan also noted oligometastatic disease in her right proximal humerus. She was started on palliative docetaxel for six cycles with palliative external beam radiotherapy. Although a variety of tumors metastasize to the bone, metastasis to the appendicular skeleton, and in particular the forearm bones, is a rare phenomenon that is poorly described in the existing literature. Skeletal metastasis may also be the primary presenting feature in a minority of cases. Lung cancer is among the more commonly associated primary sites, and further workup should include appropriate imaging to evaluate for a lung primary as well as an FDG-PET/CT or a bone scan to detect occult metastatic disease.

Introduction and importance The traumatic diaphragmatic hernia could be missed in the background of spinal fractures due to neurological weakness. We report the first case of the management of thoracolumbar fracture-dislocation associated with diaphragmatic injury. Presentation of case 53-year-old male transferred from local hospital following fallen from a motorbike on the 4th day after the injury. He was paraplegic from L1 below with sacral root involvement. Further imaging showed fracture-dislocation of the vertebral body at the T12-L1 level and anterior displacement of T11 on T12. The left-sided diaphragmatic hernia was detected by chest x-ray with bowel shadows in the left hemithorax. Emergency laparotomy and diaphragmatic repair followed by a posterior spinal exploration and pedicle screw fixation were done. Early mobilization was done after spinal fixation and the patient is successfully continuing rehabilitation. Clinical discussion Thoracolumbar fracture-dislocation associated with the traumatic diaphragmatic hernia is rare. Clinical diagnosis of associated visceral injuries could be delayed due to the neurological deficit of the patient. An initial concern was to repair the life-threatening diaphragmatic hernia. Even current studies showed improved neurological function from early spinal surgery, spinal fixation had to delay as surgery needs a prone position. Conclusion Early identification and management of traumatic diaphragmatic hernia are life-saving and allows early surgical intervention for the spine. Early reduction and fixation are associated with improved neurological function and will allow early mobilization and reduce hospital and ICU stay.