No abstract

Tibial pilon fractures result from high-energy trauma unlike usual ankle fractures. Their management provides numerous challenges to the orthopaedic surgeon including obtaining anatomic reduction of articular surface and the management of associated soft tissue injuries. This article aims to review major advances and principles that guide our practice today. We also discuss a treatment algorithm based on a staged approach to the fracture: initial spanning external fixation followed by definitive fixation.

DESCRIPTIONWe present the case of a 63-year-old lady who complained of feeling constantly tired and lethargic, and was found to have iron defi ciency anaemia. There was no history of per vaginal bleeding. Examination was normal apart from a large, mobile, fi rm, well-defi ned abdominal mass in the upper abdomen approximately 10cm in diameter. The abdominal CT scan revealed a large intra-abdominal tumour (fi gure 1). Histology of the specimen obtained by surgical resection revealed this to be a mesenteric paraganglioma (fi gure 2). To the best of our knowledge, there are eight other reported cases of mesenteric paraganglioma's. Ninety per cent of these sympathetic tissue tumours arise from the adrenals and are called phaeochromocytomas. Paraganglioma's are extra-adrenal phaeochromocytoma's, of which 85% arise in the abdomen, 12% in the thorax and the remaining 3% in the head and neck. 1 Paraganglioma's that hypersecrete catecholamines may cause signs and symptoms identical to those in patients with hyperfunctioning adrenal pheochromocytoma. Recent studies implicate genetic factors in up to 25% of cases. The most frequent causes of phaeochromocytoma susceptibility are von Hippel-Lindau disease, multiple endocrine neoplasia type 2, and the newly delineated phaeochromocytoma-paraganglioma syndrome.Germline mutations in three of the succinate dehydrogenase subunits (SDHD, SDHB and SDHC) increase susceptibility to head and neck paragangliomas, and familial and isolated phaeochromocytomas. 2 Differentiation between benign and malignant forms is diffi cult by imaging alone. There are no defi nite documented criteria for classifi cation as a malignant form apart from the presence of distant metastases, which must be proven with biopsy, because paragangliomas may exhibit multicentricity. 3Learning points ▶ Keep in mind the possible differential diagnoses at all times, as even specialised imaging such as contrast CT scans may not always provide the answer. Excision of paraganglioma's is the treatment of choice ▶ after optimisation of the patient. Formal follow-up protocol, however, is yet to be established in view of the limited number of cases. Genetic testing should be considered in all patients ▶ presenting with paraganglioma's. Figure 1 CT scan of the abdomen with intravenous contrast showed a 139×125 mm well-circumscribed mixed cystic/solid mass arising within the peritoneal cavity, to the right of the midline, displacing bowel loops. Posteriorly it was closely related to the inferior vena cave and anterior margin of the right psoas. Competing interests

We report a case of a 29-year-old man with a background history of incomplete quadriplegia, who sustained a second degree thermal burn of the lower limb from prolonged proximity to the extractor fan of his laptop. We have also reviewed all other reported cases of thermal burns associated with laptop use. This literature review highlights the variability in the extent of injury and the subsequent management of laptop induced burns.