Osteomyelitis (OM) in diabetic foot infection could have many presentations such as an infected ulcer spreading to the bone or superimposed to Charcot neuroarthropathy. However, the sausage toe as a diabetic OM presentation was very rarely investigated; therefore, this study aims to assess the prevalence and signs of this presentation along with treatment modalities and outcomes. This is a retrospective series of patients presenting a sausage toe on admission. Several methods were conducted to diagnose OM, and three treatment modalities were applied. Two groups were compared: acute and chronic sausage toes. Outcomes were defined as sausage toe prevalence, ulcer location, OM prevalence, and comparative treatment results. Out of 82 diabetic toe infection cases, 24 (30%) presented as ‘sausage toe’. The side of the proximal interphalangeal joint of the lateral toes was the most frequent ulcer location (50%), mostly on the dorsal aspect followed by the side aspect. There were 15 (62.5%) acute cases and 9 (37.5%) chronic cases. MRI showed signs of OM in 21 (87.5%) cases and signs of septic arthritis in 3 (12.5%) cases. At the final follow‐up, a successful treatment was recorded in five (20%) cases with antibiotics alone. Out of the 19 (42%) procedures, conservative surgery was performed successfully in 8 (58%) cases while amputation was needed in 11 (45.8%) cases. There was no significant difference in amputation frequency between acute and chronic groups. This is the first study documenting the sausage toe as a prevalent presentation of diabetic toe infection. The deformity is conclusive of deep infection with a very high osteomyelitis frequency. Surgery is often required for infection control and healing, mainly for chronic cases, and treatment outcomes did not differ between acute and chronic sausage toe groups. It could be beneficial to include this entity in the diabetic wound classification systems.

Introduction: Femoral neck fractures in older adults are associated with appreciable short-term mortality, yet long-term survival after hip arthroplasty is incompletely characterized. We analyzed early mortality risk factors and 5- and 10-year mortality after hemi-arthroplasty or total hip arthroplasty (THA) for femoral neck fractures. Materials and Methods: In this single-center retrospective cohort, 397 consecutive patients underwent arthroplasty for femoral neck fracture in 2014 and 2015. Mean age was 83.3 years and 70.3% were women. Demographic data, Charlson Comorbidity Index, Parker Mobility Score, medication history, operative and anesthetic details, transfusion, and peri-operative complications were extracted. Survival status up to 10 years was obtained from hospital and civil registries. p-value < 0.05 was considered statistically significant. Results: A total of 397 patients were included. When categorized by age and ASA scores into low-, medium-, and high-risk groups, mortality rates increased with higher risk (p < 0.001). The mortality rate at 30 days, 90 days, 1 year, 5 years, and 10 years postoperatively was 3.5%, 7.1%, 14.1%, 48.36% and 71.03%, respectively; mean time-to-death was 3.3 years. At 30 days, mortality was higher in males, those on clopidogrel, in patients with lower mobility (lower Parker Score), higher morbidity (higher Charlson Score), NNIS score of 1, higher ASA, patient who underwent hemiarthroplasty, and patients with medical complications post-op. Additional 90-day risks were antivitamin K therapy, immunosuppressants, and continuous spinal anesthesia; 1-year risks also encompassed advanced age, prolonged hospital stay, and peri-operative transfusion. Conclusions: Arthroplasty after femoral neck fracture is associated with high mortality rate; only half of patients survive 5 years and fewer than one-third reach 10 years. Mortality rate is affected by many risk factors, both non-modifiable factors and modifiable peri-operative variables. Targeted optimization of modifiable peri-operative factors and multidisciplinary geriatric-orthopedic care may improve outcomes in this frail population.

Hand metastases are notably rare, comprising around 0.1% of all metastatic diseases, mainly originating from lung cancer, which is responsible for 30-40% of such cases. This report highlights a rare occurrence of distal phalangeal metastasis in a patient with Lynch syndrome, underscoring the diagnostic challenges associated with hand metastases. A 70-year-old male diagnosed with Lynch syndrome 35 years ago, following colon adenocarcinoma, presented with severe inflammatory lesions on his right index finger. Patient had previous liver segmentectomies to remove metastatic lesions and had multiple cutaneous squamous cell carcinomas in various regions. Recent diagnostics, including a chest CT, identified a thoracic mass suggestive of squamous cell lung carcinoma. Histopathological analysis confirmed the metastasis of lung cancer to the index finger, necessitating a transphalangeal amputation. Hand metastases are extremely infrequent, often mimicking other conditions and requiring a high index of suspicion for accurate diagnosis. This case reinforces the lung as a frequent origin of hand metastases and the significance of elevated EGFR expression in facilitating metastatic spread. The rarity of hand metastasis in patients with genetic predispositions like Lynch syndrome calls for heightened vigilance and an integrated management approach. It highlights the critical role of histopathology in diagnosis and the need to consider genetic factors in treatment planning. Further research is encouraged to understand the mechanisms enabling certain cancers to metastasize to the hand and the role of genetic conditions in these processes.

Introduction: Carpal fractures are relatively rare, and simultaneous fractures involving both the capitate and trapezoid bones are particularly uncommon, accounting for less than 2 % of all carpal injuries. These fractures usually result from high-energy trauma, such as motor vehicle accidents. Due to the deep anatomical position and strong ligamentous support of these bones, injuries may be subtle and easily missed on standard radiographs. Early diagnosis and appropriate management are essential to avoid long-term morbidity and ensure functional recovery. Case presentation: We report the case of a 28-year-old previously healthy, non-smoking female with no known drug or food allergies, who presented with severe left wrist pain, swelling, and limited movement following a high-speed motor vehicle accident. Physical examination revealed tenderness on the dorsal aspect of the wrist with no neurovascular deficits. Radiographs raised suspicion for capitate and trapezoid fractures, which were confirmed by a CT scan showing comminuted coronal shear fractures with dorsal and radial displacement. Surgical fixation was performed and the fractures were reduced under fluoroscopic guidance and fixed with K-wires and Barouk screws. Postoperatively, a removable wrist brace was worn for six weeks, after which the patient achieved full wrist motion and pain resolution. Discussion: These fractures are challenging to diagnose and manage due to their rarity and subtle presentation. Advanced imaging, particularly CT scans, is critical for diagnosis. Early surgical intervention facilitates anatomic reduction and optimal outcomes. Conclusion: This case underscores the importance of early recognition, advanced imaging, and individualized surgical care in managing rare, complex carpal fractures. Highlights:

Giant cell tumor of bone (GCTB) is a benign yet locally aggressive neoplasm that commonly arises in the epiphyseal metaphyseal region of long bones, particularly around the knee, where management is challenged by the need to achieve complete tumor excision while preserving joint function in young, active individuals. We describe a 26-year-old female who presented with acute left knee pain and mechanical locking after squatting during exercise. Imaging demonstrated a well-defined 1.7 × 1.7 × 1.7 cm eccentric lesion in the posterior medial tibial plateau with minimal cortical breakthrough and surrounding marrow edema, and CT guided biopsy confirmed the diagnosis of GCTB. She underwent surgery through a posterior Löbbenhofer approach, including meticulous curettage, high speed burring, and phenol application. To shield the articular cartilage from the thermal effects of PMMA cement and avoid long term subchondral stiffness, a protective layer of autologous morselized bone graft was interposed between the cement and the joint surface. Recovery was uneventful, and this single-stage technique provided definitive management with no need for further surgery, ensuring structural support while minimizing recurrence risk. This case highlights the value of combining extended curettage with a graft cement interface to optimize joint preservation in periarticular GCTB and underscores the need for future studies evaluating long term radiological and functional outcomes of such hybrid reconstructions.

Introduction: Fractures involving the ankle joint typically manifest as bimalleolar or trimalleolar fractures, with isolated posterior malleolus fractures (IPMF) representing a rare subset, comprising 0.5-4 % of cases. Due to its rarity and subtle clinical presentation, IPMF poses unique diagnostic and management challenges. This case report presents the diagnosis and treatment of a 50-year-old woman with an IPMF following a fall, alongside a review of relevant literature. Case presentation: A 50-year-old woman presented with severe right ankle pain and inability to bear weight after a backward fall. Physical examination showed swelling, tenderness in the medial retromalleolar region, and pain with passive dorsiflexion. Imaging through X-rays and CT scans revealed an isolated posterior malleolus fracture involving 40 % of the tibiotalar articular surface. The patient underwent surgical fixation using two posteroanterior cannulated screws via a posterolateral approach. Post-operative X-rays confirmed adequate reduction and fixation. She remained non-weight-bearing for six weeks, followed by physical therapy. Discussion: IPMFs are challenging to diagnose due to subtle signs and limitations of standard radiographs. Advanced imaging, particularly CT with 3D reconstruction, is crucial for accurate diagnosis. Classification systems, such as Haraguchi and Mason, guide treatment. Surgical fixation is often necessary for fractures involving significant joint surfaces, displacement, or instability. Posteroanterior cannulated screws offer a minimally invasive and effective stabilization method, as demonstrated in this case. Conclusion: Early recognition and proper surgical management of IPMF are essential to prevent complications. Increased awareness and further research are needed to improve outcomes for this rare ankle injury. Highlights: