Does the type of implant have any correlation with critical fusion time of hallux metatarsophalangeal joint? There are few cadaveric biomechanical studies published in the literature assessing the strength and rigidity of different fixation methods. Although it is still unclear whether the amount of metal affects the fusion rate, the aim of this study was to assess whether using a supplementary dorsal ¼ tubular plate in addition to a compression screw gives any added rigidity to the fusion area leading to an earlier fusion.

A retrospective analysis was conducted on the first metatarsophalangeal joint fusion in 26 consecutive patients (34 feet) between April 1998 to February 2002 comparing using single screw versus a screw supplemented with a dorsal ¼ tubular plate. There were 18 females and 8 males with a mean age of 51.5 years and a mean follow-up of 2.9 years. The final fusion was assessed clinically and radiologically by trans-articular trabeculation.

There was a fusion rate of 97%. All patients except one had solid fusion. One case had non-union. Four cases had superficial wound infection, which settled down with appropriate antibiotic therapy. Paraesthesia over the dorso-medial aspect of the big toe in three patients and transfer metatarsalgia in two patients were documented.

The type of implant did not show any direct correlation with the complication rate. There is no evidence to suggest in this study relating the amount of implant to final outcome. Therefore the choice of implant fixation can be at the discretion of the operating surgeon.

In moderate and severe Hallux Valgus metatarsus varus and incongruency of the joints are often important features. Basal osteotomy and distal soft tissue release can often achieve adequate correction of intermetatarsal angle (IMA) and joint alignment.. We retrospectively evaluated the results of Basal Osteotomy in 26 feet in 20 patients between January 1999 and December 2003. American Orthopaedics Foot & Ankle Society Score (AOFAS) was used for assessment. A subjective grading system was used to check patient’s satisfaction. The surgical technique consisted of crescentic basal osteotomy, lateral distal soft tissue release and medial capsular plication according to Roger Mann. Fourteen osteotomies were fixed with K wires that needed second operation to remove them. Barouk Screw was used to fix the osteotomy in 12 feet. Patients were mobilised in High heeled shoe postoperatively. Average age was 55.2 years and average follow-up was 25.8 months. The average preoperative Hallux Valgus Angle (HVA) and IMA were 37.38° and 17.27° respectively. At follow-up the HVA and IMA averaged 13.3° and 6.4° respectively. Sixteen feet had incongruent joint preoperatively that became congruent after surgery. In 25 feet sesamoid position improved after surgery. Average AOFAS score was 88.8. 94% patients were highly satisfied and graded their results as good to excellent. One patient had AOFAS score of < 50 due to her generalised poly-arthralgia and osteoporosis. K wire was broken across the TMT joint in one case and needed removal under GA. This lead to change of our practice as we started using Barouk screw to fix the osteotomy. Other complications consisted of decreased sensations over medial side of toe in three and mild metatarsalgia in one foot. Basal osteotomies with distal soft tissue release in the treatment of Hallux valgus give good correction of the deformity and high patient satisfaction. Barouk screw provides stable fixation.

This is a retrospective study performed to analyse the functional outcome, complications and survival following intramedullary nailings for pathological fractures of long bones in a District General Hospital.

There were fifteen intramedullary nailings (Femur-11, Tibia- 2 , Humerus- 2) done in twelve patients during June 1999 and December 2002. There were twelve nailings in pathological fractures and three cases of prophylactic nailings. Nine patients had metastasis with known primary cancers from Ca Breast (3), Ca Bronchus (3), Ca Prostate (1), Ca Oesophagus (1) and Renal Cell Carcinoma (1). Two patients had metastasis without known primary site. There was one patient who had multiple myeloma with pathological fracture of femur.

We assessed the outcome of the treatment based on pain relief, post-fixation mobility and complications associated with the procedure.

Pain relief was achieved in about 92% cases. 67% cases with fracture of lower limbs were able to walk within a week postoperatively following nailing. One patient had deep infection leading to implant failure that needed nail removal to eradicate the infection. One patient had nonfatal pulmonary embolism. There was an incidence of thromboembolism of brachial artery that was treated by embolectomy without any sequelae.

The patients survival rate was 33% at six months and 0% at 2 years.

Reamings sent from nailing were helpful in confirming the diagnosis in 75% cases.

Despite poor life expectancy our results show good functional improvement following intramedullary nailing of pathological fractures of long bones. It is a safe way to restore limb function and improve quality of life.