A total absence of acute compartment syndrome (ACS) was noted in 966 tibial fractures in African patients of diverse ethnic groups, reviewed retrospectively at our institution. According to general incidences reported in the literature, we should have experienced between 22 and 86 cases of acute compartment syndrome. The purpose of this prospective study was to confirm these findings and at the same time to try to find an explanation for this phenomenon.

During a period of 1 year and 4 months, 257 tibial fractures were prospectively analyzed for clinical signs and late sequelae of acute compartment syndrome. In 156 of these patients, presenting 158 fractures of the tibia, the pressure in the anterior compartment was systematically measured. Not a single case, nor late sequel of ACS was diagnosed.

The hypothesis we forward for this total absence of ACS is the effect of chronic high temperature surroundings in preventing ACS by safeguarding the arteriovenous gradient and lowering the vascular resistance. We propose that further investigation should be carried out to study this hypothesis.

Hip arthrodesis is still a major option for the painful arthritic hip in the third world, where total hip prostheses are seldom available or too expensive for the patient. Various procedures for hip fusion have been described in the literature; they are often complex, frequently need a long period of post-operative immobilisation and are coupled with a considerable failure rate.

A new simple technique for hip arthrodesis is described without dislocating the hip preoperatively in order to maintain the oxygen concentration in the femoral head, using a self devised plate and requiring no post-operative immobilisation.

During a three year period the procedure was performed in 22 patients by the same surgeon. In all cases the indication for hip fusion was hip osteo-arthritis. The cause of osteo-arthritis was in 46% hip destruction by tuberculosis, in 23% aseptic osteonecrosis of the femoral head, mostly linked to sickle cell anaemia, in 8% complications of trauma of the hip, in 8% slipped upper femoral epiphysis and in 15% primary arthritis. Two had concurrent femoral osteotomy for correcting malposition of the limb and one had during the same procedure a femoral diaphysis osteotomy with placement of a Wagner elongating device in order to proceed with a callotasis. Mean follow up was 15.4 months. All hips, except one, achieved a solid fusion by radiographic and clinical criteria between 6 and 12 months after surgery. The failure of fusion was in the oldest patient (63 years) who presented loosening of plate and screws due to an advanced degree of osteoporosis. One superficial infection occurred that resolved under antibiotics.