Aim

To assess the results of Castles procedure performed at our hospital compared with those available in literature.

Our aim was to assess the outcome of the treatment of Segmental fracture of the humerus in adult patients.

From January 1994 to December 2003, 24 (17 females) consecutive adult patients with segmental humeral fractures were treated in our unit. Segmental fracture was defined as a two-level humeral fracture with at least one intermediate segment (AO type 12C). The mean age of the patients was 56.5 years(range 29–95) and the mean ISS was 14.1(range 9–29). The causes of injury included 8 vehicular accidents, 15 falls from heights, and 1 skiing injury. Thirteen patients had associated injuries. Three fractures were open (1 grade II, and 2 grade IIIA). At final follow up all patients were assessed in terms of radiological result and functional capacity (range of motion).

The mean follow up was 36 months (range 24–60). There were 5 radial nerve palsies. Seven cases involved 4 fracture segments. The mean length of segment was 7 cm (range 5–16). All fractures but 5(20.8%) progressed to union (1 infected non-union, 1 hypertrophic after ex-fix, 1 atrophic after stabilization with rush pins, one was associated with failure of fixation proximally and required hemiarthroplasty). The mean number of procedures to achieve union in total was 1.6(range 1–3). There was one implant failure and one persistent non-union. At final follow up, the mean abduction was 1100 (900–1400) and the mean forward flexion was 1200 (1000–1500). Internal external rotation was 700 (50–90) and 250 (20–45).

The risk of non-union is as high as 20.8 % and additional procedures often required to achieve union of the fragments. The method of stabilization depends on several factors including fracture configuration, the available bone stock and the surgeons’ expertise. Despite the severity of this injury a satisfactory outcome can be expected.

We aim to evaluate the effect of fasciotomies following compartment syndrome on the healing of closed tibia diaphyseal fractures. Between January 2002 and January 2005 165 patients were treated in our institution with closed tibial diaphyseal fractures. Patients were divided in to two groups; Group A (study group) consisted of patients that, after surgery, developed compartment syndrome and were submitted to fasciotomies and group B (control group) of patients who underwent reamed IM nailing and did not require such intervention.

Patients with open fractures, pathological fractures, revision surgery, severe brain injuries, prolonged ITU stay and severe co-morbidities were excluded. Fracture pattern, ISS score, smoking habits, drugs intake, mode of mobilization and additional procedures were prospectively documented. Fracture healing more than 24 weeks was defined as delayed union and over 36 weeks as non-union. All patients had been followed-up clinically and radiologically until fracture union.

One hundred twenty five out of 165 patients fulfilled the inclusion criteria for this study. 30 patients were classified in group A and 95 in group B. Eighteen patients of group A required skin graft coverage after the fasciotomies. There was no difference between the two groups in terms of the studied parameters. Four patients from group A and one from group B, went to non-union and required second procedures to achieve union. These patients were excluded from the final analysis. Delayed union occurred in 11 (36.6%) patients in group A and in 10 (10.5%) patients in group B (P< 0.05). Overall, fracture healing was prolonged in the fasciotomy group but the difference was not statistical significant, 24.27 weeks (10 – 48) versus 22.19 (12 – 40), (P= 0.157) in group A and group B respectively.

Compartment syndrome and fasciotomies is associated with delayed fracture healing. Nevertheless, this delay was not statistically significant different.

Aim: To evaluate the effect of fasciotomies following compartment syndrome on the healing of closed tibia diaphyseal fractures.

Patients and Methods: Between January 2002 and January 2005 165 patients were treated in our institution with closed tibial diaphyseal fractures. Patients were divided in to two groups; Group A (study group) consisted of patients that, after surgery, developed compartment syndrome and were submitted to fasciotomies and group B (control group) of patients who underwent reamed IM nailing and did not require such intervention. Patients with open fractures, pathological fractures, revision surgery, severe brain injuries, prolonged ITU stay and severe co-morbidities were excluded. Fracture pattern, ISS score, smoking habits, drugs intake, mode of mobilization and additional procedures were prospectively documented. Fracture healing more than 24 weeks was defined as delayed union and over 36 weeks as non-union. All patients had been followed-up clinically and radiologically until fracture union.

Results: One hundred twenty five out of 165 patients fulfilled the inclusion criteria for this study. 30 patients were classified in group A and 95 in group B. 18 patients of group A required skin graft coverage after the fasciotomies. There was no difference between the two groups in terms of the studied parameters. 4 patients from group A and 1 from group B, went to non-union and required second procedures to achieve union. These patients were excluded from the final analysis. Delayed union occurred in 11(percentage) patients in group A and in 10 (percentage) patients in group B (P< 0.05). Overall, fracture healing was prolonged in the fasciotomy group but the difference was not statistical significant, 24.27 weeks (10 – 48) versus 22.19 (12 – 40), (P= 0.157) in group A and group B respectively.

Conclusions: Compartment syndrome and fasciotomies is associated with delayed fracture healing. Nevertheless, this delay was not statistically significant different.