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Objectives: To evaluate the graft remodeling phase following anterior cruciate ligament reconstruction augmentation with remnant preservation. Methods: Between March and December 2018 19 patients underwent anatomic single bundle anterior cruciate ligament reconstruction using hamstrings with preservation of the intact ligament fibres and the peri-ligamentous symovium when possible. All patients were subjected to magnetic resonance imaging at 2 and 4 months post-operatively. Patient demographics, percentage of intra-operative remnant preservation and graft magnetic signal intensity using the signal/noise quotient method were recorded. Results: 12 patients were male and 7 were female with a mean age of 26. 5 years. A low signal intensity in the mid portion of the graft was observed in those patients where a larger percentage of the ligament and synovium was preserved at 2 months post-operatively. The signal intensity was even lower at the 4 month scan. Conclusions: Remnant preserving anterior cruciate ligament reconstruction seems to lead to quicker graft remodeling as reflected in the post-operative magnetic resonance signal intensity. Graft revascularization and remodeling seem to correlate with the percentage of remnant preservation. These results support the use of fast-track rehabilitation protocols in this set of patients.

Background: Elbow injuries are frequently encountered in hospital practice, while radial head fractures are the commonest result of such trauma. Diagnosis of radial head fractures is based on clinical and radiographic evaluation with a number of X-ray projections being available. A combination of views is chosen, comprising of routine elbow series screenings and modified techniques, as well as the assistance of the fat-pat sign; never the less fractures can still be occult on X-rays. Purpose: This article aims to demonstrate the diagnostic value of the sitting axial mediolateral projection, which in our hospital is referred to as the Traumatic Elbow Mediolateral Investigatory Screening (TEMIS). This projection has been successfully used in our hospital repeatedly for the identification of occult fractures that were missed by other projections. Materials and methods: 62 patients who presented to our Emergency Department due to trauma in the elbow over a six-month period were X-rayed for the identification of fractures. Projections included an anteroposterior, a lateral and TEMIS. Results: Radial head fractures (Mason type I) were identified in 14 out of 62 patients. 2 of these were only visible on the TEMIS projection, while they were missed by the other two views. Conclusion: Trauma to the elbow is a common type of injury. Minor fractures can be expected to heal with good results; complications, however, should not be underestimated. Improper healing can result in a permanently malfunctioning joint with restricted movement and stiffness. To avoid such consequences the choice of a reliable screening projection is significant. In our case the diagnostic value of the TEMIS projection lies in the fact that it shows all fractures seen on routine screenings and reveals fractures missed by them, also being well tolerated by patients due to comfortable arm placement during the screening. All in all, when a fracture is suspected on the basis of clinical signs but no radiographic evidence is seen on conventional screenings, the TEMIS view is recommended for further investigation.

Skeletal osteochondroma or osteocartilaginous exostosis represent the most common tumor of all benign bone tumors and 10-15% of all bone tumors 1 . It is a benign cartilagecapped outgrowth, connected to bone by a stalk. It can be either isolated or as part of a syndrome (Hereditary Multiple Exostosis-HME) and its progression usually stops when the skeleton is mature, after the closure of the growth plate 2 .This lesion usually involves long bones 95%, especially near the knee 36%. It can rarely be found on flat bones,

Avascular necrosis of the femoral head affects many patients annually. It results from reduced blood supply and can lead to complete loss of joint. The development of such a complication after certain types of hip trauma such as neck of femur fractures is not uncommon; nevertheless, extra-capsular fractures such as intertrochanteric ones are not a frequent cause of this complication reported at 0.5%. This case report presents the case of a 76 year-old woman who developed femoral head avascular necrosis following the fixation of her intertrochanteric fracture by an intramedullary Gamma nail. The early post-operative period suggestive of full recovery was followed by newlydeveloped symptoms of pain and reduced mobility. The removal of implants only partially alleviated symptoms while avascular necrosis was noted afterwards and was treated by a Total Hip Replacement before progression to involve the acetabulum. What is significant to stress in this case is the rarity of this complication arising after the specific trauma and operative technique. The anatomical location of the fracture does not advocate for a disruption in the femoral head's perfusion, neither does the fixation by an intramedullary approach. Nevertheless physicians should always be aware of such cases and investigate all patients with post-operative pain and/or reduced range of motion for avascular necrosis, as early recognition is essential.

The purpose of this case report is to raise awareness of an extremely rare cause of limping, in young children. Clinicians should have a high index of suspicion of a possible cuboid fracture when evaluating a young child who presents with limping. K E Y W O R D S child, cuboid, fracture, limping F I G U R E 1 (A + B): F + profile view of the left foot, 3 weeks after limping. The dotted arrows show proximal callus formation of the cuboid bone, thus revealing the cause of limping (cuboid fracture) How to cite this article: Delniotis I, Nitis G, Gekas C, Leidinger B. Cuboid fracture: An extremely rare cause of limping in a 2-year-old child.