Fractures of the humerus, forearm and wrist account for one-third of the total incidence of fractures and can be a significant burden to individuals and the community.

The management of a combination of fracture and multiligament knee injury (MKI) in traumatic knee injury remains controversial, and there are evolving treatment recommendations. Currently, there are no studies focusing on older adult patients with MKI's in combination with tibia fractures. As a result, there is no well-established treatment algorithm for older adult patients with these complex injuries. We report two cases of MKI's with concomitant fractures in patients fifty years of age or older. Both patients were treated surgically for their associated tibial plateau fractures, but were managed with conservative treatment of the multiligamentous knee injuries. We also provide a review of the literature and guidelines for older adult patients with these types of complex traumatic injuries. Early to mid term acceptable outcomes were achieved for both patients through surgical fixation of the tibial plateau fracture and conservative treatment of the ligament injuries. We propose a comprehensive treatment algorithm for management of these complex injuries.

Open Access Research Article population. Growing popularity of extreme sports participation among amateur athletes, and the advent of extreme sports competitions (X-Games, Olympics), challenge participants to push their physical limits which may lead to increased number of injuries not seen in more traditional recreational sports. The medical consequences of lower extremity joint dislocations can be life altering for these participants. Hip and knee dislocations require large forces upon impact, and have historically been associated with high-velocity motor vehicle collisions [3-5]. Knee dislocations are typically identified by complete disruption of the integrity of the tibio-femoral articulation, and often have a range of associated vascular and neurological injuries [6-8]. Hip dislocations require even higher forces than knee dislocations and are typically less common than knee dislocations [9]. Similar to knee dislocations a number of complications can be seen and are associated with these injuries [10,11]. With participation in extreme sports increasing in the U.S. especially among young adults, understanding the epidemiology of extreme sports injuries is important for the medical community and serves as a public service. Although rare injuries in the US population, we hypothesized an increased occurrence of hip and knee dislocations in the extreme sports participants. The purpose of this retrospective study was to describe the frequency and distribution of hip and knee dislocations in seven extreme sports over a six-year timespan from January 2007 to December 2012. Methods This descriptive epidemiological study was exempted from Institutional Review Board review. A publically available de-identified database was used and all appropriate ethical standards were followed. We obtained data from the Consumer Product Safety Commission's (CPSC) National Electronic Injury Surveillance System (NEISS). The NEISS is a national probability sample of 100 hospitals in the U.S. and its territories [12]. A large number of these hospitals see less than 16,830 visits per year (47), while 23 hospitals see more than 41,131 patients for year. Of the 46 participating trauma hospitals, 19 are Level

Often dermatologists are the first providers to examine patients presenting with cutaneous manifestations of an occult cardiovascular disease. Significant morbidity and mortality exist between conditions with comorbid cardiovascular and cutaneous findings, and clinicians should be cognizant of such associations. From a cardiology standpoint, an initial workup will vary based on the reason for referral but frequently consists of upper and lower extremity blood pressure, a focused history of present illness (ie, associated symptoms of exertional chest pain, exertional syncope or syncope of unknown etiology, positional chest pain), family history (rule out cardiomyopathy, sudden cardiac death, etc), and a focused physical examination with an emphasis on cardiopulmonary systems. If any concerning findings are present, a complete echocardiogram will be performed to assess for pathology, which will guide the next steps. Given the care needed to treat these patients, this review aims to provide the tools needed to aid dermatologists in detecting underlying cardiovascular diseases by their associated cutaneous findings. | CONG ENITAL C ARDIOVA SCUL AR DISE A SE | RAS/MAPK pathway disordersRas is a small but important GTPase that induces the mitogen-activated protein kinase (MAPK) cascade, a critical mechanism for all cells during embryological development. Dysregulation of the Ras-MAPK pathway leads to the characteristic craniofacial phenotypes with underlying cardiac, cutaneous, musculoskeletal, and ocular abnormalities.Mutations in the Ras/MAPK pathway result in numerous syndromes, the most common of which include Noonan syndrome, Costello syndrome, cardio-facio-cutaneous syndrome, neurofibromatosis type 1, and Noonan with multiple lentigines. These are discussed below. | Noonan syndromeNoonan syndrome (NS) is characterized by congenital heart defects and cutaneous manifestations, among other clinical findings. 1,2 The