The management of the soft tissues in pilon fractures.

Fourteen patients with 15 pilon fractures were reviewed retrospectively to analyze cases treated by open reduction and internal fixation through both anteromedial and lateral incisions. The protocol for this procedure involved objective soft-tissue evaluation, anteromedial wound closure, judicious use of primary skin grafting, and delayed primary or secondary closure for the lateral wound. Eleven fractures were treated according to the established principles of the Association for the Study on Internal Fixation (AO/ASIF). The type and incidence of wound complications were recorded. Most injuries reviewed were of the high-energy or Type III fracture as defined by Reudi and Allgower. There was only one patient with a wound complication. This technique minimized the potential for wound complication and disastrous disability.

Tibialis posterior muscle: the fifth compartment?

The posterior aspect of 51 embalmed cadaver legs in 50 cadavers was dissected to establish the prevalence of a separate compartment for the tibialis posterior muscle (TP). All dissections revealed the presence of a superficial and a deep posterior compartment. No distinct fascial septum separated the TP from the flexor digitorum longus (FDL) and flexor hallucis longus (FHL). We conclude that the TP does not commonly rest within its own osseofascial compartment and thus does not require isolated decompression for acute compartment syndrome of the leg. An incidental observation, frequently overlooked in the anatomy literature, was a supplemental tendon of origin of the FDL. In addition to the classically described tibial origin, several cadavers exhibited a proximal fibular tendon of origin for the FDL. One cadaver demonstrated the FDL to have an extensive fibular origin that completely covered the TP, forming a myotendinous fifth compartment. We feel that the variable fibular origin can explain the chronic exertional compartment syndrome of the TP described previously by Davey et al. and serves as a basis for a minor alteration in our fasciotomy technique.