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We present a novel case of a malignant transformation of an extremity soft tissue angioleiomyoma to leiomyosarcoma in a man in his late 70s who presented with a painful and increasing lump on his anterior tibia. Initial imaging and biopsy showed a benign angioleiomyoma which was excised for symptomatic reasons. An analysis of the resulting specimen revealed a 50×42×15 mm smooth muscle neoplasm consistent with angioleiomyoma with a 22×11 mm entirely intralesional nodular component in keeping with a grade 1 leiomyosarcoma. The malignant constituent of the lesion was entirely encased in benign angioleiomyoma negating the need for further surgery. Systemic staging investigation revealed no evidence of metastatic disease spread final staging as per the eighth edition of the American Joint Committee on Cancer (AJCC) Staging T1N0M0 R0 Stage 1 a. [ABSTRACT FROM AUTHOR]

A 61-year-old polytrauma patient was admitted with a right distal comminuted metaphyseal femoral fracture with intra-articular extension (Orthopaedic Trauma Association 33C2.3 classification) among other injuries. Due to the high degree of comminution and massive bone loss, this was initially managed with a dual plating open reduction internal fixation. Dual plating has shown to be a superior fixation method than single variable angle locking compression plate (VA-LCP) plating providing greater fixation in metaphyseal bone. Our case reports the failure of dual plating which required removal of metalwork and subsequent fixation using intramedullary nail and plate technique. Failure of dual plating is not well documented in the literature. The most recent radiographs taken 15 months post revision surgery show that the bone has started to heal with evidence of callus formation. [ABSTRACT FROM AUTHOR]

A 64-year-old man was referred to A&E by his general practitioner with worsening back and acute bilateral leg pain and weakness with urinary retention. His MRI scan demonstrated spinal canal stenosis at the level of L1–L2 and a diagnosis of cauda equina syndrome (CES) was made. CES is a rare neurological condition caused by compression of the central spinal nerves at the termination of the cord. CES is a surgical emergency requiring urgent assessment and treatment. The patient underwent urgent surgical decompression; however, he required a second surgery for further decompression as repeat MRI showed persistent stenosis with further extension. Intraoperative Doppler ultrasonography revealed an intradural lesion, which was surgically excised and found to be a sequestrated lumbar disc in the intrathecal space. The patient showed significant neurological improvement post revision decompression. [ABSTRACT FROM AUTHOR]

We present a case of piriformis syndrome in a woman in her 30’s following low energy trauma, presenting with unilateral lower limb weakness, altered sensation and urinary retention. CT imaging revealed a bulky piriformis muscle which was further clarified on MRI as an intramuscular haematoma within the left piriformis causing compression of the left lumbosacral plexus. Haematoma formation was exacerbated due to use of an antiplatelet medication the patient was taking for Moyamoya disease, which carries an increased risk of cerebrovascular accident. Surgical exploration of the piriformis and sciatic nerve was undertaken and confirmed a haematoma within the piriformis. A full release of the piriformis tendon was undertaken, and the sciatic nerve was inspected, no further abnormality was found. After review in clinic post-discharge, the patient reported normal sensation and normal muscle power in her feet. [ABSTRACT FROM AUTHOR]