Exposed farcture of the Medial Malleolus: the role of the reconstructive ladder

This is the first reported case of an adipofascial posterior tibial artery perforator flap in Trinidad and Tobago. The concept of the reconstruction ladder is discussed in order to illustrate the selection of this flap as the most appropriate reconstructive option. The case report describes the use of an adipofascial posterior tibial artery perforator flap to reconstruct a wound with an exposed fracture of the medial malleolus at its base.

Gas gangrene following compound fractures

The authors report on the management of 4 cases of gangrene. These cases are presented to remind clinicians of the possibility of this complication following compound injuries. Two cases were treated with hyperbaric oxygen. The importance of keen index of suspicion in the early diagnosis of gas gangrene together with the use of hyperbaric oxygen in cases of spreading myositis negates the need for mutilating surgery. (AU)

Femoral shaft fractures in children: when bone shortening is desirable in healing - abstract

Fractures of the femoral shaft are common injuries in growing children. Road traffic accidents, falls from furniture at home and falls from trees account for the majority of cases. Apart from cases of child abuse which should be suspected in toddlers with multiple injuries to the body, pathological fractures are uncommon in this age group. Open fractures are also uncommon. Whereas in the conservative treatment of adult femoral fractures, every attempt must be made to reduce the fragments as accurately as possible and, in particular, restore normal length, in growing children such degree of accuracy in reduction is not necessary. In fact, some degree of bone shortening is desirable in displaced fractures. Accurate reduction of the fragments end to end will result in an overgrowth of the affected limbs amounting to 1" in the femur and this is permanent. This poster presents our experience based on 80 cases treated over an eight-year period. The ages of the children ranged from 3 months to 12 years. All cases were treated conservatively except one eleven-year old who had to be operated on. The only complication observed was a refracture, but this proceeded to proper healing. We believe treatment of fractures of the femoral shaft in growing children, based on certain well deformed principles, should be within the reach of every practitioner. In children approaching adolescence, the potential for growth is limited. Therefore, in these children, the fracture should be managed as for adults (AU)