This case report describes an 18-year-old man with a complete common peroneal nerve motor palsy after sustaining a multiligamentous knee injury while jumping on a trampoline. He underwent anterior cruciate ligament, posterior cruciate ligament, and posterolateral corner reconstruction with neurolysis of the peroneal nerve. Despite poor initial electromyography findings, he began showing evidence of spontaneous recovery of the peroneal nerve 13 months postinjury. Late spontaneous recovery of common peroneal nerve function is possible after a multiligamentous knee injury with complete nerve palsy, signifying that conservative management with physical therapy alone may not be unreasonable.

A 10-year-old boy with arthrogryposis multiplex congenita (AMC) presented in a "Buddha position" with severely limited mobility, including bilateral hip, severe knee flexion, and clubfoot deformities. Surgical correction involved (1) bilateral femoral derotation and shortening osteotomies, knee capsulotomies, and soft-tissue releases; (2) gradual left knee extension using an external fixator; and (3) distal femoral extension osteotomies and Verebelyi-Ogston procedures for clubfoot correction. Postoperative recovery involved intensive rehabilitation and orthotic support. Improved lower limb alignment enabled the patient to transition from non-ambulatory to assisted walking with knee-ankle-foot orthosis. This proximal-to-distal approach significantly enhances autonomy in AMC patients with severe deformities.

We report a case of adolescent-onset idiopathic scoliosis of the lumbar spine in a 43-year-old woman treated with nonfusion vertebral body tethering (VBT), a controversial and unreported technique in this age group. At 6-year follow-up, clinical and radiographic improvements are maintained. She continues to live an active lifestyle and reports being pain free. We demonstrate intermediate term safety and efficacy of VBT in a single adult patient. Careful ongoing assessment of this patient is needed to determine if this procedure will have a durable outcome and lend support for adequately powered prospective multicenter studies.

A 30-year-old man presented with left proximal tibia fracture (open Grade 3A) and a transverse lateral malleolus fracture (Weber B) following direct impact injury. Computed tomography revealed a rare posteromedial tubercle fibula fracture at the posterior inferior tibiofibular ligament (PITFL) insertion, with syndesmosis disruption. Initial damage control included an external fixator. Definitive surgery, performed 10 days later, used Herbert screws and a tubular plate, along with syndesmotic screws. This case highlights a unique fracture pattern: PITFL avulsion from the fibular end which we wish to name as Patel-Sharma fragment. Identifying this fragment is essential as it needs to be fixed to ensure posterior syndesmosis ring stability.

Dorsal dislocations of the distal interphalangeal joint with associated volar base fractures of the distal phalanx are complex injuries that pose challenges for achieving stable reduction and restoring optimal joint function. This case report describes the successful management of a 40-year-old male cardiologist who sustained such an injury after a cricket ball trauma. The treatment involved a combined approach of closed reduction, dorsal extension block pinning, and intrafocal pinning of the volar base fracture. This combined technique achieved excellent radiological and functional outcomes at 1-year follow-up. The patient regained full range of motion and returned to his preinjury activities without limitations.

Case:A 73-year old man who underwent previous L2-S1 decompression presenting with new right radicular leg pain. Imaging suggests a large central disk herniation at L1-2 with possible intrathecal extension requiring surgical decompression. When positioned prone on a Jackson frame, neuromonitoring motor signals became diminished, and thus, the case was aborted. On returning to the operating room 2 days later, careful positioning in a more neutral/flexed position facilitated normal neuromonitoring signals, allowing for an uneventful intradural approach and discectomy.Conclusion:With conus-level intrathecal disk herniation, consider using prepositional neuromonitoring and avoid hyperextension with positioning to ensure neurological safety.

Case:We describe treatment of severe multilevel congenital thoracic fusion in a 3-year-old girl with Apert Syndrome by posterior element excision, posterior column osteotomies, and gradual distraction with magnetically controlled growing rods (MCGR) with 3-year follow-up. We also describe short-term follow-up with similar management in an 8-year-old patient with a congenitally fused thoracic spine from Jarcho-Levin syndrome.Conclusion:Posterior element resection and targeted posterior column osteotomies combined with gradual distraction with MCGR offers a promising treatment course for children with severe thoracic insufficiency syndrome derived from congenital fusions.

A 60-year-old man presented with a chronic right pectoralis major muscle belly tear of the lower sternal head that was missed and previously treated with tendon repair of the sternal and clavicular heads. The tear was repaired and reconstructed with an Achilles allograft. At the 1.5-year follow-up, the patient had excellent outcome scores on the Short Form Survey-36 and American Shoulder and Elbow Surgeons Scores, cosmesis, and strength. To our knowledge, this is the first report of a chronic pectoralis muscle belly tear reconstructed with an Achilles allograft, an uncommon injury traditionally treated nonoperatively.

We report the case of a 44-year-old man who sustained an Achilles tendon rupture with an associated trimalleolar fracture and traumatic peroneal dislocation of the left ankle after a snowboarding injury. These injuries have been surgically repaired; the patient has returned to all his activities 18 months after surgery. The possibility of such injuries occurring in combination should be considered. A thorough history, physical examination, and plain radiographs should be performed in higher energy trauma to the ankle. Additional diagnostic tests such as ultrasonography or magnetic resonance imaging may be used to supplement treatment. Level 5.