Based on these variables, the authors determined that external fixation is the treatment of choice for penetrating lower extremity fractures in the forward surgical environment.

Context:The scaphoid is the most commonly fractured bone in the wrist and can often be difficult to treat and manage, making healing of this fracture problematic.Evidence Acquisition:A search of the entire PubMed (MEDLINE) database using the terms scaphoid fracture management and scaphoid fracture evaluation returned several relevant anatomic and imaging references.Results:Wrist fractures most commonly occur in the scaphoid, which is implicated approximately 60% of the time. The most common mechanism of injury leading to a scaphoid fracture is a fall on an outstretched hand (FOOSH), causing a hyperextension force on the wrist. The following 2 cases, which occurred within 3 months of each other, highlight the difficulty of managing patients with possible scaphoid fractures. Neither patient had a typical FOOSH-related mechanism of injury, and neither was initially tender over the scaphoid.Conclusion:Differential diagnoses should include a scaphoid fracture with any hyperextension traumatic injury (FOOSH or non-FOOSH), even in the absence of scaphoid tenderness and when initial radiographic findings are normal.

Surgical release of the anterior and lateral compartments of the lower leg has been shown to relieve the symptoms of chronic exertional compartment syndrome. We utilize a technique that allows the surgeon to perform anterior and lateral compartment fasciotomies through a single incision while safely identifying the superficial peroneal nerve. After positioning the patient supine on the operating table with the operative extremity prepared and draped, anatomic landmarks are identified on the patient's skin. The major steps of the procedure are (1) identifying the distal end of the fibula, anterior fibular diaphysis, tibial crest, fibular head, and lateral aspect of the patella; (2) drawing the skin incision, beginning 6 to 8 cm proximal to the distal end of the fibula centered between the tibial crest and anterior fibular diaphysis and extending it 6 cm proximally; (3) making a skin incision longitudinally and dissecting the subcutaneous tissue to allow identification of the fascia and superficial peroneal nerve; (4) performing gentle neurolysis; (5) identifying the anterior and lateral compartments, making small incisions in the fascia of each compartment, and then performing fasciotomy of the lateral and then anterior compartments while protecting the superficial peroneal nerve; and (6) irrigating the wound, closing it in layers, and applying a soft, compressive dressing. Postoperatively, the patient is allowed to bear as much weight as he or she can tolerate. Current literature indicates that good-to-excellent outcomes can be expected for 90% to 95% of patients treated with fasciotomy. Military personnel and patients with posterior compartment involvement may have less reliable outcomes.