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Necrotizing fasciitis is recognized as a surgical emergency. Early detection and aggressive surgical débridement are crucial to reduce patient mortality and morbidity. There are, however, other causes of subcutaneous emphysema. We present the case of a 64 year-old patient with a history of postsurgical radiation for rectal carcinoma with subcutaneous emphysema of the thigh in the presence of urinary sepsis. Surgical exploration revealed the source of the emphysema to be an enterocutaneous fistula. The patient had an unstable and prolonged hospitalization after débridements of the thigh and abdominal surgery and was readmitted for recurrence of thigh drainage, but eventually was discharged; nine months after the initial diagnosis all wounds had healed and he was walking with a walker. Despite an otherwise benign clinical appearance, the radiographic finding of subcutaneous emphysema in the absence of penetrating trauma must be considered a case of a necrotizing soft tissue infection until proven otherwise.

Osteolysis of the distal clavicle has been reported to occur from traumatic, atraumatic (overuse), or systemic causes. Three patients with bilateral osteolysis of the distal clavicles whose osteolysis did not fit these etiologic categories were evaluated. Clinical, imaging, and laboratory evaluations were nonspecific, and histologic sections of the distal clavicle showed evidence of chronic inflammation with reactive change of the articular surface. Patients either had complete resolution or marked improvement of their symptoms after bilateral distal clavicle resection at mean followup of 5 years 3 months. These cases of osteolysis of the distal clavicle represent a category of this disorder not previously described.

The torsional and compressive biomechanical characteristics of slotted and nonslotted interlocking nails in distal femoral shaft fractures were evaluated. Slotted (Grosse-Kempf) and nonslotted (Russell-Taylor) locked nail systems were implanted in anatomic specimen femora, which were then tested in torsion and axial compression. For torsional studies, each femur was transversely sectioned distal to the isthmus; for axial loading, a distal 3-cm section of bone was removed. The mean peak torsional stiffness of the femora fixed with nonslotted nails was 0.955 Nm per degree, which was significantly greater than that (0.300 Nm per degree) for the femora fixed with the slotted nails. However, when loaded to failure in compression, the nonslotted nail group failed at a mean load of 2490 N compared with 3050 N for the group fixed with the slotted devices. These results could be due in part to the lesser rigidity of the slotted nail, which may have facilitated greater load sharing with bone and increased resistance to compression failure.