Retained metallic foreign bodies can lead to implant-associated wound infections through bacterial colonization and biofilm formation. We report a case of a wound infection associated with a retained metallic fragment caused by Staphylococcus arlettae (S. arlettae) and evaluate the organism's early biofilm formation on common implant metals. A 33-year-old man sustained a crush injury to his right hand and forearm, resulting in extensive soft-tissue damage and vascular injury. Emergency surgical management included meticulous debridement and vascular reconstruction. Postoperatively, purulent wound infection was effectively managed following microbiological identification of S. arlettae and antibiotic susceptibility-guided therapy. The treatment regimen involved serial debridement along with stepwise adjustments in antimicrobial dosing. Follow-up revealed that the patient's hand function had recovered well. In vitro assays were conducted to compare early bacterial attachment and biofilm formation of the clinical S. arlettae isolate on stainless steel 304 (SS304), stainless steel 316 (SS316), and titanium alloy (TC4). The results revealed material-dependent differences in initial adherence as well as early biofilm development, establishing a link between implant surface properties and bacterial colonization propensity. This case underscores the clinical significance of retained metallic fragments as potential foci for S. arlettae infection, emphasizing the necessity for prompt debridement, targeted antimicrobial therapy, and consideration of implant material properties. In vitro evidence demonstrating differential biofilm behavior on SS304, SS316, and TC4 has important implications for surgical decision-making, selection of implants, management of wounds, and prophylactic antibiotic strategies aimed at mitigating implant-associated infections.

Radial club hand is a rare congenital condition (1 in 100,000) involving varying deformities on the radial side of the forearm, ranging from thumb underdevelopment to absence of the radius and related structures. It can be isolated or part of syndromes, such as thrombocytopenia-absent radius, Holt-Oram, or vertebral, anal, cardiac, tracheo-esophageal, renal, limb, and is bilateral in 50-72% of cases. A 12-year-old right-handed girl presented with an isolated, non-syndromic right radial club hand and flexion deformity at the wrist and elbow, without functional impairment. Her pathology did not fit existing Bayne and Klug or Heikel classifications, as her proximal radius was absent but the distal epiphysis and wrist were developed. A corrective wedge osteotomy with bilobed skin flaps was performed to realign the forearm. No intervention was made at the wrist or musculotendinous units, resulting in an acceptable outcome. Reasonable outcome could be obtained in a rare case of complex congenital anomaly like radial club hand following a minimalist approach of wedge osteotomy alone to correct the forearm deformity.

Management of distal ulnar fractures remains controversial, partly due to its low incidence and operative challenges encountered during surgical fixation. This cadaveric study examined fracture displacement in isolated distal ulnar fractures, specifically AO Muller Q2 and Biyani Type I fracture pattern, during forearm pronosupination.6 fresh frozen cadaveric upper limbs amputated at mid-humerus were used. Soft tissues including proximal and distal radioulnar joints were carefully preserved. Specimens were inspected grossly and radiographically for absence of pathologies. Radiocarpal and midcarpal pinning was performed to facilitate quantification of forearm rotation. 2 markers were each placed proximal and distal to fracture site to quantify fracture displacement. 3-dimensional positional data was recorded using an optoelectronic system (Vicon MX motion capture system).Distance between the 2 markers increased in the proximodistal and radioulnar axis, and decreased in the dorsovolar axis when the forearm was rotated from neutral to 100° pronation. The inverse was observed during supination. Mean aggregate fracture site displacement increased to 9.17 ± 2.78 mm at 100° pronation. Statistically significant increase in aggregate fracture site displacement was observed from 60° pronation onwards. At 100° supination, the aggregate fracture site displacement was 4.58 ± 8.62 mm. When supinating from neutral to 100°, fracture displacement did not increase significantly. from this study suggest that distal ulnar fractures are potentially stable, particularly in supination. However, unrestricted forearm pronation with inadequate immobilisation might still cause further fracture displacement. Further studies are required to assess distal ulnar fracture stability in vivo before treatment guidelines can be established.

Foreign bodies that migrate into the heart may include medical devices dislodged from their original location or, rarely, external particles (shrapnel and other foreign bodies) that penetrate the vein, remain intraluminal, and migrate via the venous blood flow to the right heart. Most reported entry sites of these external foreign bodies were in the torso, thigh, or neck; none of them penetrated through a distal extremity of the body. We report a case where shrapnel was found in the right ventricle (RV) following penetrating injury to the hand. An otherwise healthy 24-year-old man presented with an isolated shrapnel injury to his right hand and forearm from an explosion trauma. Computed tomography demonstrated multiple small metal objects in the forearm, hand, and wrist. Additionally, a 3 × 3.5 mm metal object was found in the RV, consistent with a metal shrapnel embolus from the forearm. Echocardiography indicated the fragment to be in a fixed position within the RV, without any additional pathology. Even shrapnel that penetrates through the hand or forearm may migrate to the heart. In this case, following a multidisciplinary discussion, a conservative approach was recommended based on the following condition: lack of symptoms, small size of the foreign body, no obstruction of venous effluent, low risk of significant embolization to the pulmonary vasculature, absence of fever or endocarditis, no current evidence or risk of valve dysfunction, and no myocardial irritation indicated by arrhythmia. The patient was instructed to avoid magnetic resonance imaging scans.

Anterior interosseous nerve (AIN) syndrome is a rare condition characterized by isolated weakness in the flexor pollicis longus (FPL) muscle, sometimes accompanied by weakness in the index flexor digitorum profundus (FDP) muscle. In this clinical case report, an 18-year-old male presented with a right proximal both-bone forearm fracture that was sustained while playing soccer, with subsequent development of AIN palsy, without sensory deficits or progressive pain. Preoperative imaging was performed, showing a proximal third radius and mid-shaft ulna fracture. Given the progressive presentation of an acute AIN palsy, the patient was indicated for urgent operative intervention. During exploration and decompression of the AIN within the pronator tunnel, the nerve was found to be in continuity but was compressed by a large hematoma and the distal radial shaft. The patient recovered full median nerve function by his six-week postoperative examination and by his final follow-up recovered full range of motion with painless return to full activities. In proximal or mid-shaft both-bone forearm fractures, a careful neurovascular exam is essential, as uncommon conditions like anterior interosseous syndrome (AIS) can present without obvious sensory deficits or pain. Potential etiology for traumatic AIN compression includes significant fracture displacement, soft tissue injury, active extravasation on advanced imaging, and/or clinical concern for compressive hematoma. Patients presenting with FPL and/or index FDP weakness in the absence of sensory deficits or pain on passive stretch may benefit from dedicated surgical exploration and decompression of the AIN to prevent irreversible nerve damage.