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An increase of distal radius fractures was seen in 2009 when an extended cold spell allowed natural ice skating in Amsterdam. This resulted in overload of our Emergency Departments and operating rooms. This study reports patient and fracture characteristics of these injuries. We also determined potential skating-related risk factors. All patients who sustained a distal radius fracture during natural ice skating between January 3 and January 12, 2009 were included. Patient and fracture characteristics, treatment, validated outcome (Quick DASH) at 3 months after injury were determined. Natural ice skating accounted for a 5.5-fold increase of distal radius fractures (92 fractures) compared to a similar time period without natural ice skating in 2008. Fracture types were AO-type A, n = 50, type B, n = 11 and type C, n = 31. Twenty-eight patients were casted without reduction. Fifty-four patients underwent at least one reduction before casting. The non-operative group consisted of 67 patients (68 fractures, male/female 18/49) with an average age of 55.5 years. Twenty-three patients (24 fractures) underwent internal fixation. Quick DASH for the whole group was a mean of 23.1 points (range 0-95). The mean Quick DASH for the non-operatively treated group was 19.9 points (range 0-95), for the operatively treated group 31.7 points (range 2-65). Distal radius fractures increased 5.5-fold during a period with natural ice skating. Women aged 50 and over were predominantly affected. Most fractures were extra-articular, and the vast majority was treated non-operatively. Utilization of wrist-protecting devices should be considered during future natural ice periods.

A 53-year-old man presented with a shortened exo-rotated left leg and a flexed painful left hip after a soccer accident. X-ray of the hip revealed an anterior hip dislocation, for which the patient was successfully treated by reduction of the hip replacement in the operating room.

Isolated clavicle fractures are frequently encountered in the accident and emergency department. Complications of isolated clavicle fractures are rare. Pneumothorax as a complication of a clavicle fracture has only been reported five times in English literature. In all five cases the pneumothorax was treated by a thoracostomy and the clavicle fracture was treated conservatively. In our case, both pneumothorax and clavicle fracture were treated conservatively with good result. Although isolated clavicle fractures rarely present with complications and normally heal with routine immobilisation, we must be aware of the serious complications that may occur, which require urgent treatment. Thorough history, physical examination, with particular attention to the neurovascular and chest examinations and radiographs of the clavicle are necessary to prevent overlooking these potentially serious complications.

Three patients, a woman aged 46 years and two men aged 81 and 62 years, presented with abdominal pain, nausea, vomiting and/or weight loss. A small intestine follow-through series revealed a significant stenosis in all 3 patients. A laparotomic partial resection of the affected jejunum and corresponding mesentery was performed. A primary adenocarcinoma of the small intestine was diagnosed; pathology revealed that the resections were radical, and pT3N0, pT2N0 and pT3N0 stage tumours respectively. The first patient underwent a repeat operation four months later due to similar complaints caused by a tumour recurrence; fifteen months later she died from recurrent disease. The second patient was disease-free 3 years after surgery. In the third patient, liver and peritoneal metastases developed 16 months after surgery; he died 10 months after palliative chemotherapy had been initiated. Adenocarcinoma of the small intestine is a rare disease and patients often present late with aspecific complaints. This, combined with the fact that these tumours tend to follow an aggressive course, results in a poor five-year survival rate of 10-35%. Surgery is the only curative treatment currently available. A greater awareness of this type of tumour is needed for treatment results to improve.