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.

Aim: To investigate whether lateral compression type I injuries of the pelvic ring are inheritably mechanically stable.

Patients and Methods: Between January 2005 to January 2007 all consecutive admissions of a tertiary referral center for pelvic ring reconstruction with a LC I injury pattern were eligible for inclusion. Exclusion criteria were other patterns of pelvic ring injuries. All patients underwent radiological assessment including AP pelvis, inlet/outlet views and CT. Patient demographics, mechanism of injury, other associated injuries, ISS, length of hospitalisation, type of operation, mode of mobilization, preoperative and postoperative visual analogue score pain VAS and follow up until fracture union were prospectively documented. Mechanical stability of the pelvic ring was assessed in the operating theatre under general anaesthesia. Instability was defined as displacement > 2 cm of the anterior or posterior elements. The minimum follow up was 12 months.

Results: Out of 210 patients admitted with pelvic fractures, 40 fulfilled the inclusion criteria (LC1 type). There were 23 female 17 male and with a mean age of 33.5 (range 18–68). The mean ISS was 10 (range 9–19). 23 patients (group 1) were found to have more than 2 cm rotational displacement during EUA and were stabilised with SI screws posteriorly and a combination of retropubic screws, external fixator or plating anteriorly. 17 patients (group 2) exhibited minimal displacement less than 5mm and were not stabilised. Rotational instability > 2cm was characterised by complete fracture of the sacrum posteriorly. Stabilisation of the pelvic ring in group I was associated with a significant reduction of the VAS within 72 hours from surgery, early ambulation and discharge from the hospital.

Conclusion: This study supports the view that not all LCI fracture patterns are mechanically stable. Examination under anaesthesia of the pelvic ring can assist the clinician in the decision making progress.

Introduction: Loss of the cervical lordosis is a common finding on the emergency department in patients who have been involved in a car accident as well as in those who have suffered head and neck injury. The difficult circumstances, under which the plain films are usually taken, make the use of CT indispensable. Our study presents the CT findings from the cervical spine in patients with loss of the cervical lordosis.

Method-Patients We studied 120 patients from February 2003 to January 2004. Their mean age was 37 years old. Our protocol included the lateral-AP view, while in the absence of findings, except loss of cervical lordosis, from the plain films, the patients underwent spiral CT within 24 h.

Results: Fractures of the cervical spine were found in 7 patients (5,8%). In 5 of them these involved the A1–A2 level. In two patients fractures of the occipital condyles were found. One A7 fracture coexisted with an A2 fracture. No patient had neurological symptoms.

Conclusions: The complete investigation of the cervical spine at the emergency department is often quite difficult. The possible underlying injuries can be potentially life threatening. The percentage of positive findings in our study is quite high to justify the routine use of spiral CT for the detailed investigation of such patients.