Purpose: Mycetomas are progressive pseudotumours affecting the skin, soft tissue or bone caused by bacterial or fungal infection. Although the foot and ankle are often affected and considered together, mycetoma of the ankle should be considered as a separate nosological entity. The purpose of this work was to study the frequency of primary mycetoma of the ankle and describe the different anatomicoclinical variants and prognostic factors.

Material and methods: Thirty-five cases of primary mycetoma of the ankle were reviewed retrospectively. This series was selected from a total of 141 mycetomas treated between July 1998 and November 2110. There were 22 men and 13 women. The patients were farmers or cattle raisers, mostly belonging to the toucoulour and peulh ethnic groups. Mean duration of the mycetoma was six months (nine months – twenty years). The right ankle was involved in 21 cases and the left in 12, the side was not noted in two cases. A fungal cause was identified in 25 cases [black grain = 24 (Madurella mycetomatis = 8, Leptospheria senegalensis = 6, unidentified = 11) and white grain = 1 (Pseudoallescheria boydii)]. Actinomycosal infection was identified in six cases [red grain = 2 (Actinomadura pelletieri), white grain = 4 (Actinomadura madurae) and yellow grain = 1 (Streptomyces somaliensis)]. The causal agent was unidentified in four cases. Sixteen patients underwent surgical treatment, surgical treatments were scheduled for four patients, and four were treated medically.

Results: Primary mycetoma affected the ankle in 16.3% of the cases. The presence of a benign encapsulatd (37.5%) often uniretromalleolar or biretromalleolar nodule was characteristic of the fungal form. A diffuse polyfistulated (41.6%) and premalleolar form which eventually covered the entire ankle was also noted. Secondary bone infection led to osteitis and or osteoarthrtis in 54.1% of the cases. Mycetomic osteitis required amputation in 5 patients (20.8%). We noted one case of recurrence among our direct admissions and five cases among referrals.

Conclusion: Mycetoma of the ankle should be distinguished from mycetoma of the foot. The benign encapuslated fungal form is situated behind the malleolus and can be distinguished from the diffuse polyfistulated osteophilic actinomycosic or fungal form that covers the entire ankle.

Purpose: Fracture-posterior dislocation of the femoral head is an exceptional hip injury. Emergency reduction is required. Relocation into the acetabular cavity of the displaced femoral head may not be feasible. Irreducibility, instability, and more rarely accidental fracture of the femoral neck may also occur. We encountered this latter complication in four patients and report here its frequency and mechanism and propose preventive therapeutic measures.

Material and methods: Seventy dislocations and fracture-dislocations of the hip were treated in our unit from March 1997 to February 2003. Among these cases, fourteen hip dislocations were complicated by femoral head fractures. Fracture of the femoral neck occurred during reduction in four. All four cases occurred in men, mean age 49.7 years, who were traffic accident victims (drivers or passengers). There were two Pipkin IV fracture-dislocations and two Pipkin II. The first reduction, achieved under general anaesthesia in an emergency setting, was performed by an orthopaedic surgeon in one patient and a general surgeon in three patients. Arthroplasty was used to treat the femoral neck fracture in three patients and pinning in one. We reviewed retrospectively the clinical and imaging data before and after reduction.

Results: Sub-capital fracture situated 4.0 cm (mean, range 3.5–4.5 cm) from the lesser trochanter occurred in all four cases. The head remained attached above and posteriorly to the acetabulum and was rotated less than 90°. The fragment remaining in the acetabulum was displaced in two cases. In one patient, the fracture-dislocation of the head was associated with a fracture of the posterior rim of the acetabulum.

Discussion: Neck fracture during reduction of traumatic hip dislocation is a serious complication. Prevention of this iatrogenic event requires a slow, progressive reduction limiting the trauma to a minimum; first intention open surgery may be required in selected cases.