Two cases of Acute Peroneal Compartment Syndrome, without history of trauma are presented. One case had a history of prolonged horse-riding with the wearing of tight boots, the other case had a history of prolonged walking. An Acute Peroneal Compartment Syndrome should always be considered in the differential diagnosis of pain in the peroneal region of the lower limb.

BACKGROUND:The PerCutaneous Compression Plate (PCCP) was developed by Gotfried (Israel, Haifa) for minimal-approach osteosynthesis of pertrochanteric fractures.METHODS:One hundred fifteen patients, aged 60 or more, with intertrochanteric fractures (AO type 31A1 or 31A2) were selected randomly for fixation with either the PCCP (53 patients) or the Dynamic Hip Screw (62 patients). All surviving patients were scheduled for a 1-year follow-up.RESULTS:Less invasive surgical stabilization of pertrochanteric fractures with the PCCP resulted in shorter theater and surgical time and reduced postoperative pain. The PCCP treatment showed a tendency toward a lower transfusion need and a reduction of fracture impaction; however, results were not statistically significant. There was a trend toward a higher mechanical complication rate with the PCCP: anatomic closed reduction without posterior sagging of the fracture and fluoroscopic control of the placement of the first neck screw in two directions are essential to avoid technical complications.CONCLUSION:Minimal invasive treatment of pertrochanteric fractures with the PCCP reduces operation time and postoperative pain.

The percutaneous compression plate (PCCP) is a new implant for the minimally invasive treatment of pertrochanteric hip fractures that might reduce blood loss, wound problems and prevent devascularization of bone fragments. A quicker operation with minimal blood loss is better in the older patients. We performed a prospective, randomized clinical trial to compare the PCCP with the well-known dynamic hip screw (DHS). A total of 71 patients with an Evans type 1A–D pertrochanteric hip fractures were included. We measured the operation duration, blood loss, wound healing, complications, fracture healing and functional outcome. In total, 33 PCCP and 38 DHS were implanted. The mean operation times were 69.2 and 46.6min for DHS and PCCP, respectively (P=0.000). Blood transfusions were given in 24 DHS patients compared with six PCCP patients (P=0.000). There were 27 haematomas in the DHS group and eight in the PCCP group (P=0.000). There were no differences in fracture healing and the functional outcome between the two implants (P=0.767, ns). Although this is a preliminary study with a relatively small number of patients and short follow-up, the PCCP seems similar to the DHS in relation to bone healing and stability, but with significant advantages for blood loss, soft tissue healing and operation time.

Purpose: This prospective clinical study sought to evaluate the possible effects of routine compartment pressure monitoring in tibial fractures and to assess the previously published criteria.Pressures in the anterior compartment were measured in consecutive cases of tibial fractures. In 95 patients, the protocol was completed with a follow-up after 1 yr.An optimal threshold pressure with both good sensitivity and specificity could not be identified.Such monitoring is a useful tool in the diagnosis of compartment syndrome, mainly in symptomatic patients or those who are difficult to assess, but routine monitoring and the use of most popular threshold pressures, which have low specificity, can result in overtreatment. (C) 2001 Elsevier Science Ltd. All rights reserved.

Dermatotraction was evaluated as an alternative technique for the closure of dermatofasciotomy wounds, with a review of literature and of our clinical experience. The dermatotraction technique provides closure of fasciotomy wounds and avoids the use of skin grafting. Patients treated with dermatofasciotomy for an acute compartment syndrome of the limbs, without obvious tissue necrosis and without shock or urgent life saving surgery, had their fasciotomy wound closed with dermatotraction with vessel loops, the skin approximation system, or the prepositioned intracutaneous suture. In our experience, the mean time to wound closure was nine days. Dermatotraction techniques that cause local skin compression should be avoided because skin necrosis might occur (skin approximation system). Dermatotraction with vessel loops or the prepositioned intracutaneous suture provides good skin apposition without the necessity for skin grafting.

Hypothesis: To determine whether retrograde nailing of distal femoral fractures is beneficial for the elderly patient. Methods: Prospective study of consecutive patients, aged sixty-five years or older, whose distal femoral fractures were treated with a retrograde femoral nail between January 3, 1993, and April 30, 1996. Results: Twenty-four of twenty-six patients were followed for more than twelve months. There were twenty AO/ASIF 33A and four AO/ASIF 33C fractures. Twenty-three were closed. There was one Gustilo type 1 fracture. All fractures healed. Six patients did not walk before injury. Using the Neer scoring system, there were ten (56 percent) excellent (85 or more points), six (33 percent) good (70 or more points), and two (11 percent) fair (55 or more points) results; none of the cases were considered as failures (less than 55 points). Conclusions: Retrograde intramedullary nailing makes possible a biological osteosynthesis of distal femoral fractures. It also produces good functional results in elderly patients. The two major technical problems encountered with this implant are the poor hold of the distal interlocking screws and difficulties with proximal interlocking. Early weight-bearing is not advisable.

We reviewed 280 patients with tibial fractures, treated with nailing between 1992 and 1995. Diagnosis of threatening compartment syndrome was based on clinical symptomatology. In 18 patients (4,3 %) a compartment syndrome has been diagnosed. Thirteen patients underwent a fasciotomy in the first 24 hours after nailing; 2 patients after more than 24 hours after nailing and 2 patients after 48 hours. In one patient no fasciotomy was performed. Four patients suffered from serious sequellae caused by the compartment syndrome: all these patients had their decompression after 24 hours. None of the patients with dermatofasciotomy before 24 hours after the operation had persistant sequellae. If the diagnosis of compartment syndrome is made on clinical symptoms, the diagnosis and the treatment can be delayed and sequellae can be the possible result. These results confirm the need for more efficient diagnostic tools, like compartment pressure monitoring, to avoid delayed diagnosis.

The operative management of acromioclavicular dislocations is a controversial topic. The Bosworth screw coracoclavicular fixation has been promoted because it can be performed percutaneously with minimal morbidity. An earlier retrospective study carried out in our department showed frequent implant loosening and redislocation (31%). To exclude ''technical failure'' as possible cause for the high failure rate we started this prospective study. Patients were randomized in a conservatively treated group, and a group treated with coracoclavicular screw fixation. All operations were performed by senior surgeons. Computerized tomography was performed to control the position of the screw. This study showed various degrees of implant loosening or redislocation after implant removal in all five patients with screw fixation. Regarding this results we had to end the study earlier than expected and cannot recommend the coracoclavicular screw fixation in the treatment of acromioclavicular dislocations.

A patient with a severe liver injury and an acute cardiac failure due to a traumatic tricuspid valve failure is presented. During liver surgery, massive venous bleeding was caused by regurgitation of blood through the insufficient tricuspid valve. Right ventricular failure, leading to persistent hemodynamic instability, and caused by massive posttraumatic tricuspid regurgitation, has been treated with biological valve replacement. Diagnosis and management of posttraumatic tricuspid insufficiency are discussed.