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A 43-year-old patient, obese, with a history of epilepsy under antiepileptic drugs for one year that are stopped from the patient for two months, who presented a seizure causing a fall on the palm, then he was transferred to the emergency department. On admission, he was with no distress. An anteroposterior x-ray of the hand was performed, which was interpreted as normal and the patient was sutured. However, the patient presented severe pain during the suturing of the wound, the reason for which the orthopedic surgeon was requested. On examination, we noted a wound on the palm of the proximal interphalangeal joint of the third digit. The neurovascular exam was normal. The review of the anteroposterior radiograph had raised our suspicion of joint dislocation. So, we performed a lateral radiograph of the hand that revealed a posterior dislocation of the proximal interphalangeal joint of the third and fourth fingers. Following axial traction of both fingers, the reduction of both dislocations was obtained that remained stables. The flexion of the third finger was not possible, prompting the patient to undergo surgical exploration. Thus, the exploration did not found any lesion of the flexor tendon, then the wound was closed, after which both fingers were put in buddy strapping for four weeks. At this follow up, the mobilization of the digits was allowed. At a follow up of six months, the patient did well, with no recurrent dislocation, no pain and no recurrent seizure under epileptic drugs.

A 21-year-old male with six months of the instability of the ankle presented to our orthopedic department. He reported a trauma history in the ankle in which clinical and radiological findings were concluded to an ankle sprain and so a short leg was made along with oral´s analgesics and protected weight-bearing for two weeks. Following this, the pain had decreased but he reported recurrent episodes of a giving-away feeling of the ankle in sitting or kneeling. He could reproduce the dislocation by active dorsiflexion-eversion of his ankle. On the examination, he presented no deformity or wound. The palpation of the lateral side of the ankle was slightly painful. The subluxation of the peroneal tendons clinically appeared. The peroneal tendons dislocation test was positive. The X-rays of the ankle were normal. A few days later, the patient underwent surgery. The retinaculum was re-attached under the lip of the fibula by three anchors using the retromalleolar approach. After which, the ankle was placed in a below-knee, non-weight-bearing temporary cast for 2 weeks. Then walker boot cast with fully weight-bearing was allowed for 4 weeks. Following this period, physiotherapy was started. At the last follow up, the patient did well with neither instability nor ankle pain.

A 35-year-old male with one year of pain at the right index's phalanx calmed totally by anti-inflammatory drugs. Three days before his consultation, he punched the wall that occasioned pain and total impotence of the small finger. He took from himself the oral's analgesic. But, the pain got worst in both the small and index fingers, the reason for which, he consulted our orthopedic department. On admission, the clinical examination found a swelling on the dorsum of the right fifth metacarpophalangeal joint. The palpation was painful as well as in the proximal phalanx of the right index. At this follow up, the patient reported many consultations at the emergency department for the pain of the index and no radiograph was realized. X-rays of the hand (A,B) showed a boxer's fracture and circumference lytic lesion of the phalanx of the index. We elected for a surgical treatment for both the boxer fracture (osteosynthesis using two k-wires) and the lytic lesion (bloc surgical excision). On post-operative care, the patient was discharged with oral's analgesics and a well-molded cast in intrinsic plus position, to be reviewed in two weeks. Histological examination confirmed the diagnosis of osteoid osteoma of the phalanx since the typical nidus was found in the histological specimen. At the last follow up, the patient did well with no recurrent pain, the consolidation was obtained and he regained his previous activities.

A 49-year-old woman reported a gradual pain of the shoulder for 1 year. One week, before her consultation, she fell on her shoulder and the pain became intense, the reason for which, she consulted our orthopedic department. On admission, the clinical examination found a rotator cuff syndrome (tests of the infraspinatus and supraspinatus tendons were positives). The neurovascular exam was normal. The radiograph of the shoulder was normal and so an oral's analgesics were prescribed with splint elbow to the body. For the first days, she did well, but the pain persisted which obliged her, three weeks later, to revisit the orthopedic department and so a magnetic resonance imaging was performed, which revealed a 7cm benign intra-osseous lipoma in the infraspinatus fossa. A few days later, the patient underwent surgery to remove the lesion and the pathological examination confirmed the hypothesis of an intramuscular lipoma. At the last follow up, the patient did well with no recurrent pain with full recovery of the shoulder mobility.

A-35-years old man, with no history of trauma, presented pain and total impotence of the small finger following a match of basketball. The patient was transferred to our emergency department in about thirteen minutes. On admission, he was stable with no distress signs. The uninjured limb held the injured limb, and we noted a deformation at the level of the interphalangeal joint of the small finger. Palpation and mobilization of the finger were painful. The neurovascular exam was normal. The radiograph of the hand (lateral and anterior-posterior views) was realized that showed a rotatory volar dislocation of the proximal phalangeal joint with no fracture. Under digital block anesthesia, a combined slight flexion and axial traction of the phalanx were applied, after which the reduction was obtained, and it remained stable. The control radiograph confirmed the reduction. Then, a splint immobilized both proximal and distal interphalangeal joints in a neutral position along with buddy taping of the injured digit to the uninjured digit adjacent for 6 weeks. At this period, there was no instability of the collateral ligaments on exposure to passive stress after which active exercises were started. Evaluation at 6 months found that the active range of movement of the proximal interphalangeal joint was from 0o extension to 90o flexion, with no pain no recurrence of dislocation and he had returned to his full activities.

A 54-years-old man referred to our medical center for intermittent pain of his left elbow. On arrival, during the medical history taking, he reported neither old trauma of the left elbow nor weight loss. Physical examination of the elbow showed neither limitation of movements nor evidence of a palpable mass nor soft tissue swelling. X-rays of the elbow showed a cystic lesion in the distal humeral metaphysis. We performed a computed tomographic scan of the arm, which demonstrated a well-defined fat density intramedullary lesion within the distal metaphysis of the right humerus without signs of cortical destruction or periosteal reaction. Completed T1-weighted Magnetic Resonance images revealed an intramedullary lesion with an equal signal intensity to subcutaneous fat. T2-weighted images also showed a high signal intramedullary lesion similar to subcutaneous fat. According to the typical imaging findings, a symptomatic intraosseous lipoma was suspected prompting the patient to undergo surgery for curettage and bone grafting. The patient's initial postoperative course was uncomplicated and so he was discharged with an oral analgesic to be reviewed in two weeks with x-ray control of the left elbow. The histopathological findings confirmed the intraosseous lipoma of the humerus. At the last follow-up of three years, the patient showed no pain and no recurrence of the bone lesion.

A 42-year-old presented gradually a posterior pain of his left knee for one month with no trauma history. He consulted our orthopedic department. Clinical examination showed no abnormality. The radiograph was normal. Sonography of the calf revealed a baker´s cyst of the knee with no sign of compressions and so we elected for medical treatment and rest advised. Three months later, the pain got worse with irradiation to the leg along with a sensation of chest tightness, reasons for which, he was transferred to our emergency department. On admission, his blood pressure was 110/52 mmHg, pulse rate 110 beats/min, respiratory rate 23 breaths/min, SaO2 96% on room air without signs of respiratory distress. The local examination found a decrease in calf bloating of his left leg with Homan´s sign positive. The D-dimer result was positive. The blood gas sampling found hypoxia-hypocapnia. The Doppler ultrasound of the left lower limp revealed a deep venous thrombosis of the popliteal vein. In the view of the strong suspicion of pulmonary embolism, computed tomography angiography of the thorax revealed a distal bilateral pulmonary embolism and so the patient was put on anticoagulant treatment and oral´s analgesics. A few days later, we performed a magnetic resonance imaging of the knee that showed a poly-lobed baker´s cyst with compression of the pedicle (A,B) prompting the patient to undergo surgery. After anesthetic preparation, we performed the resection of the cyst (C) and the intra-operative aspect showed the thrombosis of the popliteal vein (D). At a follow up of 12 months, the patient did well with no pain no dyspnea and no recurrence of Baker cyst.

A 42-year-old man presented to the emergency department for pain at his right elbow following a fall from a bicycle onto the outstretched hand. A radiograph of the elbow was performed then an oral analgesic was prescribed with splint elbow to body. At home, the pain has decreased in intensity but it increased when he mobilized his elbow. 3 days later, he consulted our department of orthopedics for the persistence of elbow pain. Upon admission, physical examination revealed mild swelling and tenderness over the lateral aspect of the distal part of his humerus. Mobilization of the elbow was painful. The neurovascular exam was normal. X-rays of the elbow showed a displaced capitellar fracture (A, B). 3D computed tomography confirmed the type I Hahn fracture with no other lesion (C) prompting the patient to undergo surgery. A lateral approach was performed. The intra-operative aspect showed a separated capitellum from the humeral shaft then an internal fixation of the fracture using two Herbert screws was performed (D). The patient was reviewed one week later; the physical examination found no infection and neurovascular examination was normal, the x-ray control was good and rehabilitation of the elbow allowed. At three months of follow up, our patient presented a good outcome with no pain and he had regained full activities.