The Bosworth fracture is defined as a bimalleolar fracture-dislocation of the ankle, with entrapment of the fibula behind the posterior tubercle of the distal tibia. In the current orthopedic literature, not only is this fracture pattern rare, but this type of fracture-dislocation has also been reported to be near impossible to close reduce, with the majority requiring early open reduction and internal fixation to prevent complications and poor clinical outcomes. Reported early complications include compartment syndrome and soft tissue complications from repeated closed reduction attempts. Complications associated with delayed operative intervention include post-traumatic adhesive capsulitis of the ankle and ankle stiffness. We present a case study of a 34-year-old male who sustained a Bosworth fracture-dislocation of the right ankle after a skateboarding accident. We describe a successful closed reduction performed in the emergency department, with a novel closed reduction technique. The patient tolerated the procedure well, with no complications. He was then scheduled for open reduction and internal fixation five days afterward, and upon post-operative follow-up, he recovered well with no complications. This technique focuses on reduction forces applied to the proximal fibular fragment, which is entrapped behind the posterolateral portion of the tibia. We believe that the key to successful reduction is applying an anterolateral/internal rotation force to this entrapped fragment. If successful, this fracture pattern may not require admission for compartment checks or early open reduction and internal fixation, thereby preventing complications and poor clinical outcomes. Our technique allows for a successful closed reduction of Bosworth fractures; however, further research exploring this reduction technique is warranted.

Aneurysmal bone cyst (ABC) is a benign, destructive lesion characterized by a expansile fluidfilled cystic structure primarily affecting children and young adults. Common treatment modalities include arterial embolization, curette, intralesional injections and en bloc resection with instrumentation placement. We present the case of a 22-year-old patient presenting to the emergency department with an ABC in the intertrochanteric region of the right femur and a minimally displaced pathologic femoral neck fracture. Open biopsy with curettage, bone grafting and cephalomedullary nailing were performed with fracture stabilization and favorable recovery. Reports of these lesions presenting with pathologic fracture are scarce. We discuss treatment modalities and guidelines for ABCs and pathological fractures. Future studies are needed to assess clinical guidelines for the management of ABCs and pathological fractures.

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High pressure injection injuries to the hand should not be taken lightly as urgent surgical debridement is required to ensure favorable outcomes. Empiric antibiotic administration is recommended; however, few studies focus on the secondary infection risk associated with these high pressure injection injuries. We present a rare case of a patient presenting with carbapenem resistant Pseudomonas aeruginosa following a high pressure paint gun injury of the thumb. Urgent surgical debridement with administration of broad-spectrum antibiotic coverage for both gram-negative and gram-positive bacteria is recommended. The injection of foreign materials can cause extensive tissue damage and immunosuppression facilitating growth of opportunistic bacteria that are often rare in healthy adults. We advocate for obtaining cultures at initial debridement to optimize treatment in these unique and rare injection injuries. Concerns should be raised as carbapenem resistant bacteria become more prevalent in the community.

Purpose: Tibia shaft fractures account for 15% of all pediatric fractures. These fractures are often treated nonoperatively with closed reduction and long leg casting. In children treated nonoperatively, refracture can cause significant frustration to both the patient and their family in addition to a delay in resuming normal activities for several months. The purpose of this study was to investigate the rate of refracture of tibia shaft fractures treated nonoperatively at our institution. Methods: We performed a retrospective chart review of pediatric patients at one institution with the diagnosis of a tibia shaft fracture who were treated nonoperatively between January 1, 2000 and December 31, 2016. Exclusion criteria included those without complete retrievable radiographs or without radiographic confirmation of healed fracture. Patients who sustained a proximal or distal metaphysical tibia fracture or a toddler fracture were also excluded. Additionally, those with less than three months of clinic follow-up or an underlying metabolic bone disease were excluded. Data such as age, sex, body mass index, mechanism of injury, location of fracture, initial displacement, angulation, treatment, length of immobilization, and complications were recorded. The primary outcome for our study was the presence of refracture. Refracture was defined as a repeat fracture of the tibia at the same location within 18 months of the original fracture. Results: A total of 64 patients met the inclusion criteria and were included in the study. Of the 64 patients, only one patient sustained a refracture. The refracture occurred eight months after the initial injury and required operative intervention. This rate of refracture is equated to roughly 1.5%. Conclusion: Conservative management of closed tibia shaft fractures with casting is an ideal treatment for pediatric fractures. Conservative management allows for avoidance of surgical intervention and low refracture rates. This study provides support regarding the adequacy of conservative management with limited complications. Although the rate of refracture still exists, patients and families should be counseled that the rate of healing without complications is about 98.5%.