Purpose: We report a series of 46 cases of subtal instability associated or not with tibiotarsal lesions treated by Castaing ligamentoplasty between 1988 and 1999.

Material and methods: Preoperatively, symptoms were: instability, twisted ankle, recurrent ankle sprains, pain. A tarsal sinus syndrome was found in 39%. MRI was performed in all 46 patients and revealed ligamentary lesions in all case. Outcome was assessed with the Kitoaka score.

Results: At mean 5.7 years follow-up instability had resolved in 80% of the ankles. Total pain relief was noted in 63%. Physical examination demonstrated reduced motion of the subtalar joint with inversion in 43% ranging from 50% to 70% compared with healthy side, but without significant functional impact. Radiographic signs of early-stage degeneration were found in three patients. Overall outcome was very good in 82%, fair in 11%, and poor in 7%. The index of patient satisfaction was 87%.

Discussion: This series showed a correlation between body mass index greater than 26 or constitutional laxity and fair or poor results. Furthermore, longer time between the first sprain and surgical management of the residual instability led to less satisfactory final outcome. Comparison with other ligamentoplasty techniques showed similar results.

Conclusion: The Castaign procedure provides results similar to other ligamentoplasty techniques. Direct repair of the subtalar ligaments should however be preferred as the first-intention procedure, reserving Castaign ligamentoplasty for cases of failed repair.

Purpose: We report a series of 32 cases of recurrent hallux valgus treated by metatarsophalangeal arthrodesis and followed for at least five years.

Material and methods: Mean follow-up after the initial surgery was 11 years. All patients complained for pain of the forefoot. The mean phalangeal valgus was 39° with metatarsalgia in 16 cases. According to the Regnauld classification, the metatarsophalangeal space of the great toe was grade 1 in two, grade 2a in eight, grade 2b in six, and grade 3 in sixteen. Arthrodesis was achieved with an axial screw and adductor hallux plasty. Results were assessed at least five years after surgery according to the Kitaoka criteria.

Results: At last follow-up 78% of the patients were pain free. The valgus deviation was corrected with a mean angle of 19°. The arthrodesis fused in 90.6% of the cases. Statistical analysis revealed the influence of pre- and postoperative great toe valgus on the final result. The final results were less satisfactory with older age. Outcome was very good in 84%, fair in 6%, and poor in 10%.

Discussion: These results demonstrate that arthrodesis of the great toe is not an invalidating solution. Interpha-langeal joint degeneration can develop after excessive solicitation of the articulation.

Purpose: We report a series of 32 ankle fractures reviewed 15 years after osteosynthesis.

Material and methods: The series included 12 fibular fractures, 14 bimalleolar fractures, and six trimalleolar fractures. The Weber classification was: type A four, type B 18, type C ten. Postoperative radiograpphy demonstrated 28 anatomic reductions and four shortened fibulae (3 to 5 cm). The results were assessed using the Harper criteria with a Kitaoka radiographic series. The statistical analysis was done with chi square.

Results: At the review 15 years after osteosynthesis, 19 ankles were pain free. Normal mobility was noted in 22 cases, and an absence of oedema in 18. Thirty patients wore normal shoes. Walking was normal in 23 cases; the x-rays revealed tibiotalar narrowing in 12 cases, and lengthenings of the malleolus in 23. Ten cases of tibiotalar narrowings were associated with a long medial malleolus. The objective results were good in 23 cases, fair in eight and poor in one. At fifteen years follow-up, osteoarthritis had developed in 37% of the cases despite anatomic reconstruction in 28. The four fibular shortenings were associated with development of osteoarthritis. Ossification of the medial malleola corresponded to detachment of a non-medial sutured ligament. Ankle osteoarthritis, when present, was particularly well tolerated.

Discussion: The long-term results of osteosyntheis for malleolar fractures was good in this series. Success requires perfect restoration of the joint anatomy. Unlike other series reported in the literature, non-surgical treatment of the medial collateral ligament led to medial periarticular ossifications in the very long term and limited joint mobility. We propose surgical suture of the medial collateral ligament.