Purpose of study:

The presence of an L5 transverse process fracture is reported in many texts to be a marker of pelvis fracture instability. There is paucity of literature to support this view. Available studies have been performed on patients who were already known to have a pelvis fracture. No study has attempted to document the presence of this lesion in the absence of a pelvis fracture.

Primary aim: To identify the correlation between the presence of a L5 transverse process fracture and an unstable pelvic ring injury.

Secondary aim: To establish whether a L5 transverse process fracture can occur in the absence of a pelvis fracture.

Purpose: We report a locally invasive tenosynovial haemangioma infiltrating the flexor digitorum sublimis of the non dominant little finger in a sixteen year old student which was excised with part of the sublimis tendon and the A2 pulley.

Patients and Methods: Haemangiomata developing in the hand in relation to tendon and the tenosynovium (tendon sheath) are very rare. To our knowledge only three cases have been described arising in relation to the tenosynovium of the tendons of the hand only one of which showed infiltration of the underlying tendon. We report the case of a sixteen year old right hand dominant student who presented to her family doctor with a swelling on her left little finger. A magnetic resonance scan was arranged which confirmed a soft tissue lesion between the flexor tendons and the proximal phalanx of the left little finger with appearance similar to giant cell tumour of the tendon sheath. Surgical exploration demonstrated a dark red fleshy tumour that appeared to infiltrate the flexor digitorum ublimes tendon, and extend around either side of the proximal phalanx. For complete excision of the lesion the infiltrated sublimis tendon and a part of the A2 pulley were sacrificed. There was no resultant bowstringing of the profundus tendon.

Histologically the tenosynovium was expanded by a vascular lesion consisting of dilated, thin-walled vascular channels within fibrous tissue The appearances were those of a synovial haemangioma of the tenosynovium of the flexor tendons

Conclusion: Our case illustrates the pitfalls in diagnosis and the invasive potential of a synovial haemangioma which in our case had infiltrated the flexor sublimis tendon and the area around the A2 pulley. A complete surgical excision is critical to prevent recurrence.