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A 51-year-old lady with a background of rheumatoid arthritis presented to the foot and ankle clinic with pain and a typical history of Morton's neuroma. Examination revealed a palpable swelling over the right foot in the third intermetatarsal space. Following failed conservative management, the patient underwent excision of the neuroma. Histology revealed of necrotizing granulomas with peripheral palisading and no evidence of features specific to a neuroma. This has rarely been described previously and supports the concept of rheumatoid synovitis and nodules producing symptoms mimicking Morton's neuroma/metatarsalgia.Level of clinical evidence: 4

Objective: We report the unorthodox injury of the subclavian vessels by the malposition of a chest drain, for the treatment of a pneumothorax in the presence of a lateral third open fracture of the left clavicle. This case presents the first report of a ruptured subclavian vein and cephalic vein after the insertion of a chest drain for a pneumothorax. A systematic search performed in MEDLINE, EMBASE, Cochrane Library, and Web of Science found no similar cases documented in the literature. Methods: A Chest tube was inserted into the second intercostal space mid-clavicular line. Immediately postinsertion the left-hand digits were cyanosed with an absent radial pulse. An intraoperative haematoma was noted surrounding the chest drain insertion point. Vascular surgeons provided assistance and detected ruptured cephalic and subclavian veins and a punctured subclavian artery. The subclavian artery was repaired and both veins tied. The chest drain was re-inserted as per the ATLS protocol into the 4th intercostal space mid-axillary line. Upon healing of vascular repair of the subclavian artery injury the clavicle fracture was treated by use of a hook plate. Results: The patient made a good recovery, follow-up radiographs showed signs of fracture healing with complete resolution of pneumothorax and the patient was discharge from the department of orthopedic care. Conclusion: We believe that strict adherence to ATLS principles is vital as fractures of the lateral third of the left clavicle can distort anatomical landmarks. This can increase the incidence of injury to subclavian vessels due to malposition of the chest drain. Insertion of the chest drain in the fourth intercostal space mid-axillary line provides sound decompression of a pneumothorax as per ATLS protocol and reduces iatrogenic risk.

Objective: We report the unorthodox use of a retrograde intramedullary nail via antegrade technique for the treatment of a subtrochanteric pathological femur fracture in the presence of significant coxa vara. No similar use has been documented previously in literature. Methods: A standard approach to the proximal right femur was performed and standard antegrade technique used to introduce a guide wire into the proximal femur after which the femoral shaft was reamed. A 38-cm long 10 mm diameter retrograde nail was attached to the retrograde insertion and targeting device as if to perform a left sided retrograde femoral nailing. The nail was then inserted antegrade into the proximal right femur and locked. Results: The patient made a good recovery without complications and was followed up regularly at the clinic until complete healing of the fracture. Conclusion: We believe that a retrograde intramedullary nail inserted antegrade, enabling proximal locking with screws passing into the femoral head, provides a mechanically sound fixation of a subtrochanteric fracture, where a reduced neck-shaft angle precludes the use of a standard cephalo-medullary nail.