Femoral neck fracture following intramedullary nailing with misplacement of an end cup: report of two cases.

Femoral neck fracture is an unusual complication of intramedullary fixation of a broken femur. We report on two cases of femoral neck fractures attributed to misplacement of an end cup and subsequent invasive maneuvers in an effort to remove it. Iatrogenic fractures of the femoral neck during or after intramedullary nailing are reported in the medical literature. Authors associate it with many possible technical mistakes performed during the procedure, yet no complications after missed end cup placement were noted. We suggest that the fractures described below were a consequence of injury to the vascular supply and bone stock of the initially intact femoral neck.

Compartment syndrome of the foot after calcaneal fractures.

BACKGROUND: A compartment syndrome is a condition in which high pressure within a closed fascial space causes reduced blood flow with nerve and muscle ischaemia. Untreated compartment syndrome leads to ischaemia with necrosis, contractures, myofibrosis and irreversible functional impairment in the involved part of the limb. Calcaneal fractures and other kinds of foot trauma may cause acute compartment syndrome of the foot. This condition may lead to foot deformities, including clawing of the toes, weakness of the foot muscles and, ultimately, a gait disorder. MATERIAL AND METHOD: We studied 13 patients with unilateral calcaneal bone fractures. The healthy feet were examined as a control group. Data were derived from histories, physical examinations and measurements of intracompartmental pressure in three muscle compartments of the foot. RESULTS: Pressure in the foot with a calcaneal fracture was significantly higher than that on the healthy side, with pressures of 68.6 mmHg vs. 18.8 mmHg (p=0.0002) in the calcaneal (central) compartment, 49.0 mmHg vs. 14.4 mmHg (p=0.0003) in the lateral compartment, and 45.9 mmHg vs. 11.8 mmHg (p=0.0003) in the medial compartment. The pressures correlated with pain intensity rated by patients on a 10-point scale. CONCLUSIONS: Calcaneal fractures are accompanied by elevated intracompartmental pressure and symptoms of compartment syndrome. Acute compartment syndrome of the foot is very rarely diagnosed in Poland and only exceptionally treated by compartmental decompression. If left untreated, combined with deformities directly related to the fracture, it may lead to disability.

Surgical treatment of articular calcaneal fractures.

BACKGROUND: Although Leriche (in 1921) and Judet (in 1954) introduced screw or plate fixation of the broken calcaneus, surgical treatment using open anatomical reduction and stable internal osteosynthesis only appeared in the early 1980s. This was made possible by the introduction of imaging methods such as CT, which allowed for better detection of the fracture pathology and provided the basis for new surgical strategies, e.g. anatomically-shaped calcaneal plates, available since the early 1990s. MATERIAL AND METHODS: During a 3-year period (2002-2005) the authors operated 23 dislocated calcaneal fractures (19 men, 4 women, 19-57 years of age) involving the posterior calcaneo-talar joint (Sanders II and III according to CT-based classification). Treatment involved open reduction and internal fixation of the calcaneus through an extended lateral approach. Fixation was performed using lag screws and a reconstruction plate. We describe both the anatomic results (evaluation of the posterior articular surface of the calcaneus and the Bohler angle) and the functional outcome, using the Creighton-Nebraska system. RESULTS: In this prospectively evaluated group we achieved 12 good and 11 very good anatomical results, and 2 fair, 16 good and 5 very good functional outcomes at follow-up (at least one year after surgery). Infections occurred in 3 cases. CONCLUSIONS: The treatment option described here requires careful preoperative planning, with evaluation of the fracture pattern and patient condition, and good surgical expertise, but it provides good medium-term (1-3 years) outcome. The presence ofa good or very good reduction does not always correlate with the functional outcome.