Ipsilateral fractures of the femoral neck and shaft.

Ipsilateral hip and femur fractures are uncommon injuries. Failure to recognize the femoral neck fracture can lead to difficult complications. With proper and prompt treatment, the end results have been very satisfactory. On the basis of experience with 12 cases, the recommended treatment consists of a closed intramedullary fixation of the shaft fracture followed by ASIF cancellous screw fixation of the neck fracture.

Closed fixation of femoral shaft fractures using the schneider intramedullary nail.

A modification of the closed intramedullary nailing technique of Kuntscher was used in 102 femoral shaft fractures over a 30 month period. In the technique described here, the Schneider intramedullary femoral nail is used instead of the hollow cloverleaf Kuntscher nail, and the femoral canal is reamed only to 12 millimeters instead of the 16 to 20 millimeters recommended by Kuntscher. As with the original closed Kuntscher technique, this method has been applied toa broad variety of femoral shaft fractures including grossly comminuted, segmental, and eccentrically situated fractures. Despite the inclusion of these difficult-to-treat fractures, the complications have been few, blood loss has been minimal, and healing of the fractures with early abundant circumferential callus has been noted. The authors believe that the closed technique in treatment of femoral shaft fractures is the treatment of choice and have used the Schneider nail because it can be used with rather limited reaming of the medullary canal, and is less apt to bind in the femoral canal. Although the technique of insertion differs from the open technique, the nail itself can be used without modifications.

Abduction contracture: an unusual complication in the treatment of acute capital femoral epiphysiolysis.

A significant abduction contracture of the hip followed closed reduction and pinning of an acute slip of the proximal femoral epiphysis in a 13-year-old boy. The contracture was corrected by removal of this bony prominence. Over-reduction of the slipped epiphysis into valgus is thought to have stimulated bony overgrowth at the posteromedial aspect of the capital femoral epiphyseal-neck junction. This causes a block to adduction by abutting against the inferior lip of the acetabulum. To our knowledge, this complication has not been previously reported.

Injury patterns in motorcycle accidents.

A retrospective study of 260 cases of motorcycle accidents which occurred over a 4 1/2 year period is reported. Approximately 8% died of their injuries. The vulnerability of the tibia to open fractures is noted, and the frequent association of these open injuries with severe contamination and devitalization of tissues resulting in a high complication rate. Severely comminuted intraarticular fractures of the distal tibia and radius were numerous, and one is tempted to name the injury the "motorcycle radius." Traumatic amputations were few and all involved the lower extremity. Fractures of the cervical and thoracic spine numbered only one each, but in each instance severe neurologic sequelae ensued. A plea is made for more accident prevention measures including protective equipment and driver education specific for the motorcyclist.

Coccidioidal spondylitis.

A review of twelve cases in which disseminated coccidioidomycosis caused localized infection of the spine showed that eight of the twelve patients were alive and well with no evidence of active infection an average of eleven years after onset (range, two to thirty-five years). One patient who was followed for more than twenty-three years had a slowly developing neurological impairment in the lower extremities as a result of lumbosarcral destruction instability. One patient died early in the course of the disease from fulminating cervical spondylitis and quadriplegia. A second patient had a paraplegia from thoracic spondylitis. On patient had no evidence of active spondylitis five years after the onset of the disease, but then died of coccidioidal meningitis. All patients were treated with intravenous amphotericin at some time in the course of their illness, although its effect was not always dramatic. The three patients with neurological impairment did not undergo spine fusion, but most of the others had that operation. Surgical evacuation of abscesses and debridement of infected bone was also performed in many cases.