Purpose of the study: The aim of this work was to study the functional and radiological results as well as any complications obtained after minimally invasive treatment of bimalleolar fractures.

Material and methods: The series included 100 fractures in 100 patients who underwent surgery between 1998 and 2000: 52 men and 48 women, mean age 47.1 years (range 17–96 years). According to the AO classification, the fractures were A:18, B:62, C:20. Osteosynthesis of the lateral malleolus was achieved with a Rush nail in 95 cases and with a K-wire in six. Closed osteosynthe-sis was achieved in 67 cases, an open procedure being used for 33 cases. Osteosynthesis was performed on the medial malleolus in 73 patients, 65 with a 3.5-mm screw, a K-wire for five, and a tutor-wire in two, all during an open procedure. The functional outcome was assessed at last follow-up using the Olerund and MOlander and the AOFAS scores.

Results: Mean follow-up was thirteen months (range 3–54 months). All fractures healed at mean eight weeks (range 6–24 weeks). At last follow-up, 90 ankles were radiographically anatomic. Mean function scores were: Olerund and Molander 73.5/90; AOFAS 85.8/100. Clinical outcome (Olerund and Molander) was excellent or good in 86 patients, poor in 12 and very poor in two. According to the AOFAS score, clinical outcome was excellent or good in 90 patients, poor in 9 and very poor in one. Considered by gender and type of reduction of the lateral malleolus, there was no difference in the distribution of the clinical outcome. There was however a strong correlation between the quality of the anatomic result and the functional outcome since poor anatomic results gave poor functional results in 80% of cases. The type of anatomic fracture had a certain importance since excellent and good results were obtained for type A fractures (94%) and type C fractures (90%) but 70% of the poor results were observed in type B fractures. There were few complications: two superficial infections, four cases of reflex dystrophy, and one thromboembolic event.

Conclusion: Compared with other operative techniques, the advantages of this method are basically linked to the ability to respond to all the different forms of bimalleo-lar fracture, irrespective of the anatomic type. The operative protocol is well established. The procedure is easy to perform and rapid and provides excellent results.

Purpose: Isolated paralysis of the great toe long extensor is a rare complication of leg fractures. In certain patients, an erroneous diagnosis of compartment syndrome or muscle incarceration may be made.

Material and methods: We dissected ten fresh cadavers.

Results: The great toe long extensor was innervated by a branch of the deep fibular nerve which arose 15 cm from the talocrural joint space and directly in contact with the periosteum of the tibial shaft. In this localisation, the branch can be directly sectioned during trauma, reduction, or reaming.

Discussion: We had one patient aged 30 years with a fracture of the mid third of the leg who was treated by centromedullar nailing. Postoperatively, this patient developed isolated paralysis of the great toe long extensor. The isolated neurogenic origin of this paralysis was confirmed by electromyography.

Conclusion: This case is illustrative of direct injury of the great toe long extensor innervation, a cause which to our knowledge has not been previously described.

Purpose: Compartment syndrome of the leg is an exceptional (0.8% of leg fractures) but serious complication with a risk of muscle necrosis. The purpose of this work was to propose an original therapeutic approach to compartment syndromes that have progressed to the stage of muscle necrosis.

Material and method: Between November 1999 and January 2001, we treated eleven patients with acute compartment syndrome of the leg. There were ten men and one women, mean age 38 year (range 19–70). The causal mechanism was fracture of the two leg bones in nine patients (during the study period, 129 leg fractures were managed in the unit). For two patients the causal mechanism was prolonged compression. The compartment syndrome was present at admission in seven patients and developed after nailing in two. Emergency aponeurotomy was performed in all cases.

Results: Mean follow-up was six months, range 3 – 26 months. Outcome was favourable in six patients and the aponeurotomy was closed between day 5 and 10 (mean day 7), associated with a skin graft in some patients. Muscle necrosis developed in four patients. These patients were treated by wide muscle excision and immediate wound closure with aspiration drainage, followed by a prolonged adapted antibiotic regimen. Complete healing with total regression of the infectious syndrome was achieved. Partial recovery of sensory and motor function was obtained in all cases. One patient required a cross-leg flap for cover after infectious necrosis. One other patient aged 57 years died a few hours after aponeurotomy due to cardiac failure of undetermined origin.

Discussion: Compartment syndrome is a recognised surgical emergency. All authors recommend emergency aponeurotomy. There is no standard treatment after progression to muscle necrosis.

Conclusion: Muscle necrosis is not uncommon despite aponeurotomy (4 out of 11 patients in our series). In case of muscle necrosis, we propose wide excision and immediate wound closure associated with adapted antibiotics. Despite the muscle excision, partial recovery of sensorial and motor function of the foot was achieved several months after the initial treatment.