Fractures in patients who have myelomeningocele.

Thirty-seven (20 per cent) of 186 children who had myelomeningocele whose records were reviewed had sustained a total of seventy-six fractures. The frequency with which the fractures occurred was related directly to the level of neurological involvement. Thirteen (41 per cent) of the patients who had involvement at the thoracic level, fifteen (36 per cent) who had involvement at the upper lumbar level, eight (10 per cent) who had involvement at the lower lumbar level, and one (3 per cent) who had involvement at the sacral level sustained fractures. Sixty-five (86 per cent) of the fractures occurred before the child was nine years old, fifty-eight (76 per cent) were judged to be secondary to the limb being in a cast, and seventy-four (97 per cent) involved the lower extremity. Eleven patients, all of whom had thoracic or upper lumbar involvement, sustained fractures of multiple extremities. All fractures of the lower extremity were distal to the level of neurological involvement; they occurred predominantly in the femur in patients who had thoracic involvement and in the tibia in patients who had lumbar involvement. All of the metaphyseal and diaphyseal fractures healed satisfactorily, whether they were treated by immobilization in a plaster cast or in a bulky Webril dressing, although there were fewer complications in the latter group. The seven fractures that involved the physeal plate were a major problem, as three (43 per cent) had delayed union and two (29 per cent) developed premature growth arrest.

Maisonneuve fracture: case report of a missed diagnosis.

We report the case of a Maisonneuve fracture of the fibula in which the diagnosis was initially missed. The patient presented with a chief complaint of medial ankle pain. Rentograms of the ankle were unremarkable, and the proximal fibula was not examined. He returned four days later with increased pain, at which time examination revealed tenderness along the proximal fibula and medial ankle. Roentgenograms showed widening of the medial joint space of the ankle and an oblique crush of the proximal fibula. The patient underwent open reduction and internal fixation of the syndesmosis and repair of the deltoid ligament, and recovered uneventfully. Physical examination of ankle injuries should include the proximal fibula.

Posterior tibial tendon rupture in pronation-external rotation ankle fractures.

We have recently treated two patients with closed pronation-external rotation bimalleolar ankle fractures. During the surgical explorations, an avulsion type rupture of the posterior tibial tendon was observed. Open reduction and internal fixation of the fracture in conjunction with primary tendon repair has produced excellent clinical results. We wish to report these two cases of this uncommon injury. More important, we wish to point out the association of the tendon rupture in conjunction with a particular type of fracture pattern.