Purpose of the study: Wounds of the calcaneal tendon are common, but less well documented compared with tears of the same tendon. We performed a retrospective analysis of the epidemiological, therapeutic and prognostic features of this injury.

Material and method: The series included 70 patients collected from 1992 to 2002; 56 male and 14 female. Mean age was 22 years (range 4–70 years). The right ankle was involved in 42 cases. Causes were broken glass injury (44%), automobile accidents (22%), aggressions (18%) and motorcycle wheel injuries (10%).

Results: The diagnosis was obvious at admission. A surgical exploration was systematic to determine the partial or complete nature of the injury. Surgical treatment involved tendon repair with a cage or frame in 65 patients. A plantar plasty was needed in three patients. Bosworth tendinoplasty was performed in two other patients. The three cases with skin loss were treated by directed wound healing (n=2) and MacFarlane flap (n=1). Postoperative complications were: infection (n=11) and functional (n=10, shoe conflict). The scar remained disgraceful in 20 patients. Outcome was good or very good according to the Schmitt criteria in 92% of patients.

Discussion: Wounds of the calcaneal tendon are common, and are generally observed in young male patients. The diagnosis is clinical. The goal of treatment, either by simple suture or by pasty, is to restore normal ankle function. Because of the risk of infection, as well as the risk of a poorly healed scar preventing proper use of shoes, any surgical procedure must be as minimally traumatic as possible and performed under rigorous conditions. Adequate immobilisation and rehabilitation are required for good outcome. The prognosis is generally good.

Purpose of the study: Injury to peripheral nerves are common. Excessive tension on the suture can be a source of connective tissue reaction and ischemia unfavourable for nerve regeneration. A nerve graft is usually proposed to avoid this problem. The technique we propose was inspired by the one reported by De Medinacelli of which it reproduces solely the principle of distant recruitment.

Material and methods: We used an aponeurotic platform or a hemitendinous platform harvested at the site of the injury. Distant anchorage was sutured with a 7/O thread. The two nerve ends were brought together by rolling the aponeurotic platform around a fine forceps. The section cut was abutted with 10/0 sutures.

Results: This method has been used in 42 patients since 1995 and was preceded by an experimental phase in the rat. It has allowed us to abut nerve ends retracted up to 2.5 cm for large nerve trunks. Preliminary results are globally similar to those of an epiperineural suture or a nerve graft, depending on the case.

Discussion: This technique avoids the complexity of the princeps method of De Medinacelli. It is also much less costly. It also broadens potential indications for direct suture and reduces the need for nerve grafts.

Purpose of the study: To our knowledge, only qualitative data is available concerning the tension placed on the first carpometacarpal ligaments as a function of joint motion. The three articles published in the literature have provided discordant data. We conducted a quantitative study.

Material and methods:

Digitalized computed tomographies of the carpometacarpal joints magnified threefold were fed to a Stratasys® machine which created a rapid «polystyrene shock» prototype of the first and second metacarpals as well as the trapezium and the trapezoid.

Results: The anterior oblique ligament was under tension in the positions close to extension (positions L and D). The posterior oblique ligament was under tension in the position of ulnar finger opposition and in volar abduction (positions K and F). The inter-osseous ligament was under ension in volar abduction, opposition and flexion (positions F, K, J). A complex behavior was observed, best described by two portions, medial and lateral.

Discussion: This preliminary study on a model system depended on the interpretation of the ligament and joint surface anatomy. The method of creating joint motion described by Pieron enables comparison between two studies but does not correspond to the physiological position.

Conclusion: For a small-sized joint, magnification of the bony pieces and use of optical magnification facilitates apprehension of ligament lengthening during joint motion. This method can be used to better assess maximal range of motion according to ligament deformations observed in relation to joint solicitation.