Congenital insensitivity to pain is a rare inherited disorder that requires the combined skills of paediatricians, neurologists and orthopaedic surgeons.

Background: Capitellar fractures are rare injuries. There continues to be controversy regarding the management of these injuries. Case Study: Because of the lack of studies focusing on type II capitellar fractures, we report a case of such an injury, which was treated by open reduction and internal fixation using Kirschner wires and absorbable sutures through drill holes on the lateral surface of the epicondyle. The recommended treatment of displaced type II capitellar fractures appears to be excision, however, this may not always give a satisfactory outcome. Our patient went on to achieve a good functional outcome with no complications. Conclusion: To our knowledge, this mode of fixation of a displaced type II injury has not been described before.

We report on identical traumatic injuries in a pair of monozygotic (identical) twins treated at the same unit, one year apart. Both had sustained a complete tear of the patellar tendon and were treated surgically.

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Introduction With advancing age, frailty, multi-morbidity and need for care, elderly patients are some of the most vulnerable to Covid-19 disease. In NHS Tayside, a dedicated Covid-19 Medicine for the Elderly (MFE) Team was formed to care for patients identified as frail and likely to benefit from comprehensive geriatric assessment. Methods All Covid-19 patients meeting frailty criteria1, cared for by the Covid-19 MFE Team were identified. Data on outcomes and clinical characteristics for all (140) patients admitted during the first pandemic wave (March–July 2020) was collected using electronic patient records and analysed. Results Patients were predominantly male (58.6%). Ages ranged from 65–99 years, with 43.6% aged ≥85 years. 82.1% had one or more of cough, fever and anosmia on admission fitting Covid-19 case definition 2. Lymphopenia was present in 92.1%. Of note, 26.5% of patients had a normal or unchanged chest x-ray report, with only 10.2% showing bilateral peripheral infiltrates. 28-day mortality was 37.1% with Covid-19 Disease listed as primary cause of death in 90.4%. Conclusion(s) Entering further “waves” of infection, it is vital that we understand the clinical presentation and course of Covid-19 disease in elderly patients. Our data highlights that any Covid-19 symptom, even in isolation, should raise suspicion of disease. Chest x-rays should not be used alone as a diagnostic tool. The presence of lymphopenia should raise suspicion of Covid-19 infection. In developing an understanding of how elderly patients with Covid-19 present, we can ensure early identification and initiation of appropriate infection control measures. References 1. Healthcare Improvement Scotland. Think Frailty. 2014. http://www.healthcareimprovementscotland.org/his/idoc.ashx?docid=8abd8530-48f3-4152-bbfb-d0918b870ec9&version=-1 2. Scottish Government. Update to Coronavirus Symptoms 2020. https://www.gov.scot/news/update-to-coronavirus-symptoms