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Background: Bertolotti syndrome is the association of lumbosacral transitional vertebrae and low back pain or sciatica. Lumbosacral transitional vertebrae are vertebrae with large transverse processes that (1) articulate or fuse with the sacrum or ilium and (2) have a caudal disc space. Bertolotti syndrome is relatively common, with an incidence of 4.6% to 7% in patients with low back pain. The exact etiology of Bertolotti syndrome remains uncertain, although several hypotheses have been proposed. Case Report: A 17-year-old male presented with a long history of low back pain refractory to conservative treatment including medications, activity modification, and physical therapy. Unilateral Bertolotti syndrome was suspected. The diagnosis was confirmed with bupivacaine injection at the transitional articulation. The patient was treated with surgical resection of his enlarged left-sided L5 transverse process, resulting in complete resolution of pain. Conclusion: Lumbosacral transitional vertebrae are relatively common, so Bertolotti syndrome should be on the list of differential diagnoses for low back pain., (©2022 by the author(s); Creative Commons Attribution License (CC BY).)

Background: Multiple closed spontaneous pulley ruptures are rare injuries and require surgical reconstruction to prevent functional deficits. Pulley rupture combined with avulsion of the flexor digitorum superficialis (FDS) tendon is an even more uncommon occurrence. Case Report: We describe a closed traumatic annular 2 (A2) through annular 4 (A4) pulley rupture with avulsion of the FDS tendon. This uniquely associated pathology was treated with a complex surgical reconstruction that corrected flexion contracture and tendon bowstringing in the left long finger. The desired outcome was achieved through A2 and A4 pulley reconstruction using an autologous palmaris longus tendon graft with FDS tendon excision and proximal interphalangeal joint capsulotomy. Conclusion: Multiple pulley rupture is not commonly combined with FDS avulsion, and treatment of this injury requires careful surgical planning based on pulley biomechanics to maximize postoperative function., (©2021 by the author(s); Creative Commons Attribution License (CC BY).)

Background: Isolated dislocation of the carpometacarpal (CMC) joints is a rare injury that accounts for less than 1% of hand injuries. Few cases of isolated volar dislocations of the fifth CMC joint have been reported, making such injuries worthy of reporting. Given the rarity of these injuries, they are easily overlooked in the emergency setting and thus require a high index of clinical suspicion. Case Report: A 57-year-old female sustained an isolated volar dislocation of the fifth CMC joint when she fell onto her outstretched right hand. Physical examination revealed an inability to move the fifth digit, and the patient reported severe pain over the ulnar aspect of her right hand. X-rays of the right wrist revealed the dislocation. The patient was managed with closed reduction and application of an ulnar gutter splint. Conclusion: Solitary dislocations of any CMC joint are less common than simultaneous dislocation of multiple CMC joints, especially at the fifth CMC joint with volar dislocation. Because of the potential long-term adverse effects of untreated dislocations, these injuries must not be overlooked. Thus, patients presenting to the emergency department after traumatic injury involving an axial loading force to the hand should be carefully evaluated., (©2020 by the author(s); Creative Commons Attribution License (CC BY).)

Background: Metacarpophalangeal (MCP) joint dislocations are the result of a hyperextension injury. Complex MCP joint dislocations-those that are irreducible to closed maneuvers and require surgical intervention-are considered uncommon, even in the pediatric population. Although several structures have been identified that contribute to irreducible dislocations, the volar plate is the most significant barrier to reduction through interposition into the MCP joint. Key differences that require consideration for MCP joint dislocations in pediatric patients include ligamentous laxity, the absence of sesamoid bones, the possibility for cartilage fractures, and the possibility of growth arrest. Open surgical intervention for a complex MCP joint dislocation is performed through either the volar or dorsal approach. Controversy exists about which approach is superior., Case Report: We present the case of a 7-year-old female who sustained a complex MCP joint dislocation of the index finger. After numerous unsuccessful attempts at closed reduction, the patient underwent open reduction through the dorsal approach. The phalangeal head had buttonholed through the volar plate and was reduced by using a Freer elevator as a lever and applying gentle traction and flexion. At 4-week follow-up, the patient was pain-free and had regained nearly full range of motion of the index finger MCP joint., Conclusion: In addition to the classic volar and dorsal approaches, different techniques have been used to reduce complex dislocations in pediatric patients, including arthroscopic surgery, a percutaneous technique with manipulation of a skin hook, and a percutaneous technique with a dorsal incision. As demonstrated in this case, open reduction through the dorsal approach remains a viable treatment option for complex MCP joint dislocations in the pediatric population.