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Periampullary carcinoma is one of the rarest cancers worldwide and causes >30,000 deaths annually in the United States (US). These cancers arise in close approximation to the papilla of Vater and include tumors of the distal common bile duct, ampullary region, duodenum, and pancreas. The clinical characteristics and curative approaches of the periampullary tumor spectrum are almost similar; however, their long-term outcomes are generally different. In this report, a case of periampullary adenocarcinoma was presented, diagnosed during the first trimester of a woman. As it is quite a rare entity in pregnancy, it should be suspected when patients complain of epigastric pain and jaundice with laboratory parameters suggestive of biliary tract obstruction during pregnancy to avoid misdiagnosis. The need to optimize both maternal and fetal outcomes is essentially challenging when surgical interventions are required for staging and various therapeutic purposes. Keywords: Pregnancy; Magnetic Resonance Imaging; Endoscopic Retrograde Cholangiopancreatography.

Abstract Motorbike spoke wheel injuries (SWIs) among children are a notable public health concern, especially in low and middle-income regions. The primary objective of this study is to comprehensively examine the patterns of motorbike spoke wheel injuries (SWIs) in children. Additionally, the study introduces a novel classification system for these injuries. The implementation of this classification system aims to streamline the management of SWIs, making it more efficient and facilitating the development of standardized treatment protocols. This prospective observational study was conducted in the Accident and Emergency Department from January 2019 to 2021. Children

Abstract Objective This is the first study to establish the utility of extended curettage with or without bone allograft for Grade II giant cell tumors GCTs around the knee joint with the aim of exploring postoperative functional outcomes. Methods We retrospectively reviewed 25 cases of Campanacci grade II GCTs undergoing extended curettage between January 2014 and December 2019. The participants were divided into two groups: one group of 12 patients underwent extended curettage with bone allograft and bone cement, while the other group of 13 patients underwent extended curettage with bone cement only. Quality of life was assessed by the Revised Musculoskeletal Tumor Society Score and by the Knee score of the Knee Society; recurrence and complications were assessed for each cohort at the last follow-up. The Fisher test and two-sample t-tests were used to compare the categorical and continuous outcomes, respectively. Results The mean age was 28.09 (7.44) years old, with 10 (40%) males and 15 females (60%). The distal femur and the proximal tibia were involved in 13 (52%) and in 12 (48%) patients, respectively. There was no significant difference in the musculoskeletal tumor society score (25.75 versus 27.41; p= 0.178), in the knee society score (78.67 versus 81.46; p= 0.33), recurrence (0 versus 0%; p= 1), and complications (25 versus 7.69%; p= 0.21). Conclusions Extended curettage with or without bone allograft have similar functional outcomes for the knee without any major difference in the incidence of recurrence and of complications for Grade II GCTs. However, surgical convenience and cost-effectiveness might favor the bone cement only, while long-term osteoarthritis prevention needs to be investigated to favor bone allograft.

Purpose: The purpose of this literature review is to examine the current evidence regarding the timing of surgical intervention for acetabular fractures and to explore the outcomes of early versus late surgical management. Additionally, this review aims to evaluate the experiences of low-resource settings in managing acetabular fractures. Method: A systematic literature search was conducted using electronic databases to identify relevant studies published between 2010 and 2022. Inclusion criteria consisted of studies that assessed the timing of surgical intervention for acetabular fractures and reported on outcomes such as pain, functional outcomes, and radiographic healing. A total of 22 studies were included in this review. Literature Review: The literature review revealed conflicting evidence regarding the optimal timing of surgical intervention for acetabular fractures. Some studies suggested that early intervention leads to improved outcomes in terms of pain relief, functional outcomes, and radiographic healing. However, other studies found no significant differences in outcomes between early and delayed surgical management. The experience of low-resource settings also showed comparable outcomes to those of high-income settings, although studies in these settings were limited. Results: The results of this literature review suggest that the timing of surgical intervention for acetabular fractures remains controversial. While some studies suggest that early intervention may result in better outcomes, others found no significant differences in outcomes between early and delayed surgery. Furthermore, the experience of low-resource settings suggests that successful outcomes can be achieved despite limited resources. However, further studies in these settings are needed to better understand the challenges and limitations of managing acetabular fractures in low-resource settings.

Background: Femoral neck fractures are challenging injuries that can lead to non-union and avascular necrosis (AVN), particularly in cases of delayed presentation. Muscle pedicle bone grafting has been suggested as a potential approach to supplement blood supply to the fracture site. The objective of this study was to evaluate the efficacy of Meyer's procedure in the treatment of ununited femoral neck fractures with grade I and II AVN, which involves internal fixation and quadratus femoris-based muscle pedicle bone grafting. Methods: Five patients with delayed presentation of femoral neck fractures with grade I and II AVN were included in this retrospective study. The surgical approach for all patients was Meyer's procedure, consisting of open reduction and internal fixation followed by a muscle pedicle graft and cancellous bone graft. Fixation was done with parallel cannulated screws or non-cannulated cancellous screws. In all cases, the quadratus femoris muscle pedicle graft was utilized. The average follow-up duration was three years. Results: All five patients achieved radiological union and reported excellent functional outcomes, including the ability to perform activities such as squatting and sitting cross-legged. According to the Salvatti and Wilson hip rating system, three cases had excellent results, one had good results, and one had fair results. Two cases had coxa vara, and one case had temporary loss of scrotal sensation as complications. Avascular necrosis and transient foot drop were not observed in any cases. Using the modified Harris hip score, all cases achieved good or excellent outcomes, with an average follow-up period of 130 weeks and radiological union occurring at an average of 6.5 months. Conclusion: Meyer's procedure provides stable internal fixation and enhanced blood supply to promote union in ununited femoral neck fractures with grade I and II AVN. This technique can achieve good or excellent functional outcomes and may represent a viable treatment option for patients with these types of fractures. However, further research is needed to confirm these findings and optimize treatment strategies.