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Talar fractures associated with ipsilateral femoral shaft fractures have been occasionally reported, but an unexpectedly high potential for simultaneous occurrence of the fractures in head-on collisions has not been well documented. We treated three patients with ipsilateral femoral shaft and talar fractures in a 2-year period starting in 2000. The patients were male, aged 25, 34 and 40 years, polytraumatized with other injuries. In all cases, the fractures occurred in the right lower extremities of drivers involved in head-on collisions. The talar fractures were not detected at the initial diagnosis. We considered that the feet had been dorsiflexed and exposed to an axial load from the front when the drivers pushed the brake pedals. This condition was considered to cause both fractures. Careful examination should be carried out to rule out talar fractures in swollen feet associated with femoral shaft fractures in head-on collisions.

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A 31-year-old construction worker had been suffering from both the motion pain and the restriction of elevation in his right shoulder due to severe varus deformity of humeral neck, which occurred after proximal humeral fracture. The angle for shoulder flexion and abduction was restricted to 50 and 80 degrees, respectively. Valgus closing-wedge osteotomy followed by the internal fixation using a locking plate was carried out at 12 months after injury. Postoperatively, the head-shaft angle of the humerus improved from 65 to 138 degrees. Active flexion and abduction angles improved from 80 to 135 degrees and from 50 to 135 degrees, respectively. However, the patient complained from a sharp pain with a clicking sound during shoulder abduction even after removal of the locking plate. Since subacromial steroid injection temporarily relieved his shoulder pain, we assumed that the secondary subacromial impingement was provoked after osteotomy. Thus, arthroscopic subacromial decompression was carried out at 27 months after the initial operation, which finally relieved his symptoms. In the valgus closing-wedge osteotomy, surgeons should pay attention to the condition of subacromial space to avoid causing the secondary subacromial impingement.

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