Fat embolism syndrome (FES) is a continuum of fat emboli. Variants of FES: acute fulminant form and classic FES are postulated to represent two different pathomechanisms. Acute fulminant FES occurs during the first 24 h. It is attributed to massive mechanical blockage pulmonary vasculature by the fat emboli. The classic FES typically has a latency period of 24-36 h manifestation of respiratory failure and other signs of fat embolism. Progression of asymptomatic fat embolism with FES frequently represents inadequate treatment of hypovolaemic shock. We present a rare case of two variants of FES evolving in a patient with multiple fractures to emphasis the importance of adequate and appropriate treatment of shock in preventing the development of FES. Since supportive therapy which is a ventilatory support remains as the treatment of FES, it is appropriate to treat FES in the intensive care unit setting.

Chronic neglected subtalar dislocation associated with a non-union talar neck fracture is rare and never documented before. The lack of information from the literature on the optimal management prompted us to describe our experience in the management of this condition. We reported a case of a 57-year-old women presented with this injury. A satisfactory outcome was obtained using a tibio-talo-calcaneal arthrodesis through a plantar approach.

Unstable open fracture of the distal ulna with severe soft tissue disruption in association with distal end radius fracture may be beyond the scope of fixation. There is little scientific support to guide the management of this devastating fracture. We opted to perform a distal ulna resection in a young patient at the time of definitive rigid fixation of the distal radius and successfully managed to close the wound primarily. This technique has provided a reproducibly satisfactory reconstruction and maintenance of reasonably near normal wrist joint biomechanics.

Pulled elbow in children below 2 years of age is relatively uncommon. We illustrate 2 cases presenting the characteristic features of pulled elbow but was misdiagnosed as soft tissue injury. Diagnosis was established 12 hours later for the first case and 48 hours later for the second case after referral to the orthopaedic paediatric unit. The authors emphasized the importance of recognizing this syndrome and vigilantly treating it with closed manipulative reduction.