A 37-year-old woman was diagnosed with an isolated proximal tibiofibular joint dislocation (PTJD) after an accident during gymnastic exercise. The dislocation has a low incidence rate and is often missed in the emergency department as physical and radiology signs are subtle. Treatment consists of closed or open reduction and immobilisation. When it is not recognised it is associated with significant peroneal nerve injury.

Seventeen years after its introduction, topical negative pressure (TNP), in particular Vacuum Assisted Closure (VAC), is widely accepted as a treatment for complicated acute and, increasingly, chronic wounds. Indications for its use include:

We would like to congratulate our colleagues, Musab U. Saeed and Donald J. Kennedy, on publication of their article "A retained sponge is a complication of vacuumassisted closure therapy." 1 In the August issue of Wounds, we published a similar article about a patient with a chronic fistula in the lower leg 5 years after vacuumassisted closure therapy. 2 On a magnetic resonance imaging scan a 4.5-cm sinus tract was identified. The sinus tract led to a sinus in the center in which a roughly shaped structure was identified, which was suspected to be a foreign body. On exploration in the theater, this turned out to be an old polyurethane sponge.We agree with the authors that a retained sponge is a serious complication and can generate morbidity to the patient. In addition to thorough inspection of the wound cavity and using radio-opaque markers, we suggest not only to note and count the number of pieces of sponge used for a dressing but also to connect separate pieces together. This can be performed with either stitching or stapling different pieces together. Using this method, the loss of foam dressings will be reduced to a minimum because it is impossible to remove 1 dressing piece without removing the other. When all pieces are identified, the staples or stitches can be removed.By performing these simple safety measures, the loss of pieces of sponges can be reduced; thus, avoiding unnecessary physical and psychological discomfort to the patient.

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This article describes a series of four patients for whom a Reverdin graft was performed. The Reverdin graft, also known as a pinch graft, is a method to promote epithelialization for superficial wounds. The intervention is minimally invasive with a short learning curve. The procedure and its advantages and disadvantages are discussed in this case series. This pinch graft is a widely accepted, minimally invasive intervention to accelerate the epithelialization of wounds.

Introduction Sliding hip screws (SHS) or cephallomedullary nails (CMN) are the fixation methods for proximal femur fractures (AO 31-A2). There is no consensus on the preferred treatment. 2-4% of these proximal femur fractures treated with a CMN develop a nonunion. Our objective was to review our results when replacing the CMN with a SHS in treating nonunion of trochanteric fractures. Method From 2013 until 2020, information was collected regarding all patients with a nonunion of a proximal femur fracture (AO 31-A2) that were initially treated with a CMN in a non-academic teaching hospital with a high volume of proximal femur fractures. All patients with a nonunion of the proximal femur fracture underwent an operation where the CMN was replaced with a SHS. Baseline characteristics were recorded, as well as union rate and complications regarding the secondary surgery. Results In total 15 patients were treated with removal of the CMN and placement of the SHS in the study period. 80% were female, average age was 72.3 years when primary surgery was performed. Most patients complained of pain during weight bearing due to the nonunion (N = 13). Mean time until revision surgery was 9.6 months. Consolidation of the nonunion was achieved in 93.3% of the cases. Pain relief was accomplished within 2 months. Complications were registered in 5 patients. Conclusion A SHS is an easy and effective secondary intervention when dealing with a nonunion of a trochanteric fracture (AO 31-A2) with high union rates without the necessity for bone grafting. Due to the higher complication rate in revision surgery, the patient should be well informed prior to surgery.

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