1. Fifty-nine patients with various inter-carpal dislocations have been reviewed. 2. In this series trans-scapho-perilunar fracture-dislocation was the commonest injury. Early cases can be reduced by closed manipulation but in late cases operative reduction is usually advisable. When the injury is more than three months old, arthrodesis of the wrist joint is indicated. 3. When trans-scapho-perilunar fracture-dislocation was complicated by avascular necrosis of the proximal scaphoid fragment, the results in a small series treated by early excision were approximately equal to those treated by continued immobilisation. The results of grafting the scaphoid were poor. 4. Dislocations of the lunate seen within ten days of injury could usually be reduced with good results; no such case developed Kienböck's disease within the period of review. In late cases excision gave satisfactory results. 5. Forward dislocation of the lunate with half the scaphoid gave good results when manual reduction succeeded, but the results of excision of fragments were less satisfactory. 6. There was one case of forward dislocation of the lunate together with the distal half of the scaphoid. 7. Subluxation of the scaphoid is disclose in antero-posterior radiographs by a typical gap between it and the lunate bone. The subluxation may become recurrent and present a characteristic syndrome. 8. Other rare dislocations of the carpal bones are described.

A 45-year-old woman previously fit and well, developed a pseudoaneurysm of the breast following core needle biopsy. She was ultimately reassured and discharged without further intervention. Pseudoaneurysm is a rare complication of core needle biopsy which, contrary to previously published cases, can be managed conservatively.

Background Chyle leak (CL) is an uncommon complication of pancreatico‐duodenectomy (PD). Its incidence, risk factors, and effect on prognosis are not well described and optimum management remains debated. This study aims to calculate incidence of CL following PD and identify risk factors. Following a literature review, we have proposed a management algorithm. Methods This is a retrospective review of all patients who underwent PD between January 2006 and April 2020 at a tertiary hepatopancreaticobiliary unit in the UK. The following data were obtained: age, gender, American Society of Anesthesiologists grade, body mass index, co‐morbidities, duration of surgery, tumour histology, length of stay and mortality. Results A total of 560 patients were included. Seventeen developed CL (3.04%). Median age was 64 years (range 50–81). Sixteen (94.1%) patients still had their surgical drain in at the time of CL diagnosis. One (5.9%) did not and had free intra‐abdominal fluid on computed tomography; a diagnosis was made after an ultrasound‐guided drain had been inserted. CL patients were more likely to have higher body mass index (mean 30.5 kg/m2 (range 17–43) versus 26.7 kg/m2 (22–38)) (P = 0.02) and longer duration of operation (mean 6.2 h (range 4.3–9.0) versus 5.6 (3.0–11.0)) (P = 0.03). All cases of CL resolved without operative intervention. CL did not affect length of stay (median 10 days (range 4–41) versus 11 (4–34)). Conclusions In our series, 3.04% of patients who underwent PD developed CL. No patients required a return to theatre, and none had CL recurrence.

In this single-institution study, the diagnosis of VTE was significantly associated with overweight and obesity. Further study is needed to fully define this association.

Background Pancreatoduodenectomy (PD) remains the only curative‐intent treatment option for patients with cancer affecting the head of the pancreas. It is high‐risk and overall morbidity is around 40%. Due to the necessary resection and subsequent anastomoses required, multiple procedure‐specific complications are possible. An in‐depth understanding of the recent evidence on these will guide the consenting process and allow surgeons to evaluate their own performance. We aimed to consolidate the recent literature on preselected PD complications (postoperative pancreatic fistula (POPF), bile leak (BL), gastrojejunal leak, postpancreatectomy haemorrhage (PPH), cholangitis, and chyle leak (CL)). Methods A search of the PubMed database was carried out on 1st July 2021. Articles from July 2011 through to July 2021 were included. The initial search returned 297 results. After screening, 226 articles were excluded. The remaining 71 were assessed for eligibility and a further 34 were excluded. 37 were included in the final synthesis (two meta‐analyses and 35 single/multicentre studies). Results Due to recently updated diagnostic criteria, differing definitions among authors and subclinical cases, true incidence rates are difficult to appreciate. The following were obtained: POPF (excluding biochemical leak): 10.0–25.9%, BL: 3.0–7.9%, gastrojejunal anastomotic leak: 0.4–1.2%, PPH: 7.3–13.6%, cholangitis: 0.05–21.1% and CL: 2.6–19.0%. Numerous risk factors, both modifiable and non‐modifiable, were identified for each. Conclusion Most of the recent evidence on the studied complications comes from single institution studies of retrospective design. Robust case–control studies are required so predictive models can estimate the likelihood of specific complications in individual patients.

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The severe acute respiratory syndrome coronavirus (SARS-CoV-2) pandemic has disrupted normal health care utilization patterns worldwide, including decreasing emergency department (ED) visits for various medical emergencies. We examined whether this pattern was present in febrile pediatric oncology patients. In this single-center cohort study, we conducted a retrospective chart review of ED visits of febrile pediatric oncology patients during the first 4 months of the global SARS-CoV-2 pandemic and compared those data to the same time periods in the previous 2 years. During the first 5 months of the pandemic, 25 pediatric oncology patients with fever visited our ED; 65 children visited during the same time period in 2018; and 60 visited in 2019. Compared with 2018 and 2019, encounters for 2020 were decreased by 62% and 58%, respectively. A significantly higher percentage of febrile pediatric oncology patients (84%) were admitted to our hospital during the pandemic compared the previous years (58%). Of concern is the possibility that fear of exposure to coronavirus disease-19 (COVID-19) at our health care facility prompted caregivers of pediatric oncology patients to avoid seeking care for their child with fever. Consistent communication with families about the life-threatening nature of fever should be prioritized among pediatric oncology providers.

Objectives-To review the outcome of surgery undertaken to stabilise the neck in patients with rheumatoid arthritis performed over a five year period, to compare the results with those of previous reports, and to identify factors that may predict surgical outcome. Methods-Outcome was assessed at time ofdischarge from hospital after surgery by review of patients' notes, and at follow up by patient interview, clinical examination, anonymous questionnaire, and cervical spine radiograph. The Ranawat classification of neurological impairment and Steinbrocker functional classification were used.Results-Thirty nine patients underwent 44 procedures; 28 patients were available for review after a mean period of 29'8 months (range 12-65 months). Fourteen patients had preoperative neurological impairment and were available for follow up; 13 returned the questionnaire. Four (29%) had improved Ranawat class, nine were unchanged, and one had deteriorated. Nine (69%/.) reported a subjective improvement in neurological symptoms by questionnaire, even though the Ranawat class was unchanged in five. Twenty five of the patients reviewed had pain before operation; 21 returned the questionnaire. Pain relief was reported by direct questioning and questionnaire in 76% and 67% of patients, respectively. Overall, 67% felt that surgery had been successful. Surgery was more successful in producing symptomatic relief in patients with neck or radicular pain than in those with neurological deficit, but did prevent progression of neurological symptoms. Conclusions-Our results are similar to those from other centres. Overall patient satisfaction with surgery was good. Surgery was more likely to produce symptomatic relief in patients with neck or radicular pain before operation than in those with neurological deficit. The greater subjective improvement in neurological symptoms as judged by questionnaire probably reflects the relative insensitivity of the Ranawat classification in detecting change in neurological status; previous reports of poor outcome for patients with neurological symptoms who undergo surgery may in part be a reflection of the insensitivity ofthis method of assessment.No clear factors emerged which allowed prediction of those patients at greatest risk of operative mortality. In particular, an increased risk of neurological compromise appeared to confer no additional risk of immediate perioperative death. Our data support the suggestion that early surgery to correct symptomatic atlantoaxial subluxation may prevent progression of instability.