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Background. Appendiceal diverticulitis is a rare cause of inflammation of the appendix, which may mimic acute appendicitis. Its diagnosis is often delayed, and its occurrence carries an increased risk of significant complications, such as perforation. Case Presentation. A 23-year-old woman presented with sudden onset, severe, right lower quadrant abdominal pain and nausea. Her WBC was elevated, and abdominal CT showed findings indicative of acute appendicitis with a 13 mm fluid-filled appendix and local stranding. During laparoscopic appendectomy, significant inflammation was found around the appendix with some mucous material around the tip. The appendix base was not involved, and an endoloop was used to secure the stump. No other intra-abdominal abnormalities were observed. The patient recovered uneventfully. Pathology showed no classic appendicitis but appendiceal diverticulitis with signs of perforation. Discussion. Appendiceal diverticulitis is a rare condition which cannot be distinguished from acute appendicits clinically and on imaging. Diagnosis may be established based on pathology such as in our case. Appendectomy is indicated in appendiceal diverticulitis, and an appendix diverticulum is incidentally found during surgery or other investigations. This is due to the increased risk of perforation and the reported development of malignant tumors, including the appendix carcinoid.

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Irreversible electroporation (IRE) is a non-thermal ablative technique for unresectable liver malignancies deemed unsuitable for traditional thermal ablation due to proximity to biliary and/or vascular structures. Needle tract tumour seeding is a well-recognised complication following thermal ablation, while little is known about its risk with IRE use. We present a case of tumour seeding after IRE for unresectable hepatocellular carcinoma in a man in his 70s. The procedure was complicated by bleeding from a pseudoaneurysm, which required coil embolisation and blood transfusion. He initially progressed well, however, imaging at 12 months indicated a new tumour in the right intercostal space along the tract of one of the IRE needles; consistent with seeding. Although the patient subsequently underwent systemic therapy with sorafenib, his disease progressed, and unfortunately he passed away 20 months following IRE. This report adds to mounting evidence of needle tract tumour seeding as a complication following IRE.

Background. Morgagni hernias are rare in adults and may be asymptomatic but, nevertheless, require surgical repair, with laparoscopy offering an excellent option. The colon dislodged into the chest through diaphragmatic hernias may be affected by various disorders, including malignancies. Case Report. A 70-year-old obese male presented with fatigue and shortness of breath. CT scan showed the right colon lodged in the chest through a Morgagni hernia. He was anaemic, and colonoscopy revealed a colon cancer. He underwent combined laparoscopic hernia repair with bioabsorbable mesh and right hemicolectomy. Recovery was uneventful, but the patient died 5 months later from chemotherapy-associated cardiac failure. Literature review revealed eight similar published cases, and including ours, there were seven Morgagni hernias, one traumatic hernia, and one Bochdalek hernia. Median age of the five men and four women was 66 (range 49-85) years. Surgical approach was thoracotomy (2), laparotomy (5), and laparoscopy (2). Conclusion. Outcome of the rare condition is determined by the course of the colon cancer. Hernia repair was successful in ours and all other published cases. A combined laparoscopic approach can be safely done.

The use of trabecular metal (TM) implants in spine and joint surgery is well documented. However, their use has yet to be reported as an alternative to either allograft or autograft in the management of fracture non-unions. We present our experience in using a TM implant for treating a patient with a long-standing ulnar fracture non-union. Excision of devitalised bone resulted in a 17 mm defect which the TM implant was used to infill. The defect was then bridged with a locking plate. At 2-year clinical and radiographic review, bony union and a pain-free return to full function was noted. In this case, the use of a TM implant avoided the morbidity associated with an iliac crest autograft.

• Background – During the initial peak of the COVID-19 pandemic in the United Kingdom (UK) admissions related to acute proximal femoral fracture (APFF) remained consistent.• Aims – This aim of this research is to demonstrate the impact of the COVID-19 pandemic on this cohort of high-risk patients and provide revenues for improvement in their care as we globally progress through further peaks of viral transmission and illness.• Methods– Retrospective, observational, cohort study of 112 patients with APFF; sustained during the first peak of the pandemic (1st March – 15th May, 2020). Following ethical approval, data was collected from electronic records. Included patients were those who had been admitted to one of two district general hospitals in Northwest England. Only patients with APFF were included – chronic, peri-prosthetic, femoral shaft and open fractures were excluded. Patients were split into two groups: COVID-positive (N = 17) and COVID-negative (N = 95) with the primary outcome measure being 30-day mortality.• Results – 17.9% overall mortality (29.4% for COVID-positive and 15.7% for COVID-negative). The odds ratio for mortality was 2.2 in the COVID-positive group compared to the COVID-negative group (95% confidence level; 0.68–7.23).• Conclusions – Patients with APFF suffered increased mortality during the initial peak of the COVID-19 pandemic. However, increased mortality in COVID-positive patients, compared to the COVID-negative patients, was not statistically significant. Increased mortality in COVID-negative patients may have been due to other pandemic related factors including: undiagnosed COVID-19; patient demographics and the effects of changes to the service provision structure of the orthopaedic department during this time. Moving forward, as the global fight against COVID-19 continues, we provide the below recommendations as suggested revenues to improve 30-day mortality for these patients during pandemic times:• repeated COVID-19 testing for all APFF patients;• strict separation of COVID-suspected, COVID-positive, and COVID-negative patients;• preservation of acute trauma services, including protected theatre time; and• maintenance of experienced orthopaedic teams on wards throughout periods of re-deployment.Further research with larger sample sizes is needed to assess the national and international applicability of these recommendations.