Chronic distal biceps tendon rupture is a relatively uncommon situation with difficulties in treatment. Surgical treatment with allograft has been described in the literature with varying results. The purpose of this study was to describe 9 cases of chronic distal biceps tendon rupture which have been treated in our unit with local soft tissue as a graft.

All patients were male with an average age of 54 years. The mean interval between tendon rupture and reconstruction was 11 months. In all patients a flap from lacertus fibrosus was used in continuation with the remnants of the tendon. The flap was entubulated and advanced to the bicipital tuberocity. The biceps was released and mobilized as necessary. In addition, 3 patients underwent a fractional lengthening of the muscle. All procedures were performed through a single anterior approach. Anchors and anchor sutures were used to stabilize the tendon to the tuberocity.

The mean follow up was 3 years. No complications were encountered except for a superficial infection which resolved with oral antibiotics. All patients returned to their previous occupation. Furthermore, they all achieved 5/5 muscle strength regarding flexion and supination on manual testing. According to the Mayo Elbow performance score, the results were excellent in 8 patients, and fair in one.

We believe that the aforementioned technique is useful in treating chronic biceps ruptures. It requires no additional cost and also the risk, even if marginal, of transmitting diseases with allografts, such Achilles tendon is avoided. Furthermore, the possibility of rerupture is minimal compared to the techniques using allograft or free autografts, since a revascularisation process during which the risk for failure is high does not take place as in other types of allografts.

Forefoot involvement in rheumatoid arthritis (RA) is extremely common and the majority of the patients with RA have active foot symptoms and signs of the disease. This rertospective study was undertaken to assess the outcomes and complications in the surgery of the forefoot RA.

Seventeen patients (27 feet) with RA underwent surgical correction for the forefoot deformities. Antero-posterior and lateral weight bearing radiographs of all feet were taken preoperatively. The forefoot deformities seen with RA varied and included hallux valgus with subluxed metatarsophalangeal (MTP) joint in 23 feet, hallux valgus with dislocation of the MTP in 4, hammer or claw toes in 12 and 8 feet respectively. In addition, all 27 feet presented with variable levels of intermetatarsal deviations or widening. All the patients with hallux valgus underwent first MTP joint arthrodesis with various techniques. Deformities of the lesser toes were treated in all but 3 cases with resection arthroplasty, while the remaining 3 feet received a Weil osteotomy. Postoperatively the toes and the MTP joints were stabilised with K-wires for 6–8 weeks.

All patients have been studied for a minimum follow up of 9 months. Twenty six patients were satisfied by the outcome of the surgical treatment. Only one patient complained of persistent metatarsalgia postoperatively. The surgical complications included 2 cases of delayed union, 5 cases of delayed wound healing, 2 cases of wound infection, and 4 cases of plantar callosity. Overall, 4 patients required reoperation.

Even though complications occur in patients with RA who undergo surgical correction of the forefoot deformities, most of these complications can be treated successfully. Thus, the overall outcome of the surgical treatment is good leading to satisfactory correction of the forefoot deformities and to pain elimination

Aim: Postraumatic elbow stiffness is a common condition after elbow trauma. Sometimes it is a quite disabling symptom not responding to conservative measures. We present the surgical treatment of such cases of posttraumatic elbow stiffness.

Material: Twenty three patients, fourteen male and nine female with an average age of 34 yrs, underwent a surgical treatment of their stiff elbow. The average preoperative range of motion regarding elbow flexion-extension was 65° and the average rotational movement was 123°. All patients had received a resection of the anterior capsule, release or resection of posterior elements, removal of loose bodies and resection of osseous beaks if it was necessary. Two patients received a triceps lengthening. The results evaluated with the Mayo Elbow Performance Score.

Results: The average follow up was twenty nine months. All the patients were available for clinical assessment. There was an improvement of the average ROM to 115°, regarding flexion extension and to 164° regarding supination pronn. Postoperatively a dynamic elbow splint was used in twenty patients and a hinged external fixator in the remaining patients. Revision elbow release was performed in three patients and in one patient the elbow stiffness was deteriorated. Sixteen patients had an excellent or good result, and seven had a fair or poor one.

Conclusion: Elbow stiffness is an extremely disabling condition causing a functional impairment. Surgical elbow release is quite reliable, and relatively safe procedure given the fact that the patient follows strictly the rehabilitation protocol.

Backround: To present the results in a series of patients with complex distal radius fractures featuring comminution of the articular surface and the metaphysis in whom we used a volar as well as a dorsal approach in order to control the axial alignment and reconstitute the articular surface.

Material: There were sixteen patients with an average age of 26 years. All the fractures were classified as C3 according to AO Universal Classification. All the patients underwent an open reduction and internal fixation through a dorsal as well as a volar approach. Secondary operations were necessary for five patients.

Results: The average extension was 56, the average flexion was 51, pronation 70 and supination 76. The grip strength was 75% of the contralateral hand. The average ulnar inclination was 20°, 3 dorsal inclination, 0.9 mm ulnar variance and 1 mm articular incongruity. Three patients had radiological signs of radiocarpal arthritis. Excellent or good results achieved in the 40% of the patients according to the system of Green and O’Brien

Conclusion: The combination of dorsal and volar approach it is necessary for the carpus to be well aligned in order to achieve stability and give the opportunity for early mobilization. Sometimes additional operations are necessary.

Aim: To retrospectively review the results of the use of adductor digiti quinti flap in failed cases of primary carpal tunnel tunnel release. The concept under this procedure is to provide a highly vascularised bed for axonal regeneration.

Material: Twenty cases of failed carpal tunnel release included in the study. The average age of patients was 43 years. There were thirteen female and five male patients. In two cases, one male and one female the procedure performed bilaterally.

All patients had a repeat of release ading a neurolysis of the median nerve. The adducor digiti quinti flap was dissected up to its neurovascular bundle and flipped over..

Results: In thirteen cases the procedure was successful as this was detected objectively and subjectively. In four cases the situation was unchanged and in three a revision surgery required for decompression of the nerve. Complex regional pain syndrome developed in three cases.

Conclusion: Although postoperative healing and rehabilitation time is lengthy due to more extensile dissection, pain relief, motor and sensory improvement, and hand dexterity justify the procedure.