Purpose

Our understanding of the spectrum of pathological lesions of the shoulder anterior capsular-labral complex in anterior instability continues to evolve. In a previous study using magnetic resonance arthrography we have showed three variants of the essential lesion of the anterior capsular-labral complex. This is the first large arthroscopic study to finely evaluate the nature and relative proportions of these three lesions in anterior instability.

To assess the outcome of Wilson’s osteotomy of the first metatarsal to correct Hallux Valgus.

Two hundred and forty feet in 172 patients who had surgery for pain were reviewed clinically and radiologically. Age ranged from 28 to 82 years (mean 55 years) and duration of follow-up ranged from 2 to 15 years (mean 6 years). A mini external fixation was used to stabilize the osteotomy.

The average AOFAS score improved from 51.6 to 89.5 points at the last follow-up. In 96% of the cases, the final outcome was satisfactory as far symptomatic improvement was concerned. A 4% only was dissatisfied with the outcome of the surgery due to metatar-salgia, restricted first metatarsophalangeal joint motion or lack of correction. There were no cases of avascular necrosis of the metatarsal head. We had five cases of delayed union but they didn’t need further surgery.

The average preoperative HVA and IMA were 34.80 (range: 180–540) and 15.10 (range: 100–290), while the average postoperative HVA and IMA were 16.10 (range: 70–280) and 7.20 (range: 30–90) respectively.

Wilson’s osteotomy as a method of treatment of Hallux Valgus is technically straightforward, effective and with a predictable outcome. We believe that the external fixation offered increased stability at the osteotomy site and could be the reason why patients had a very low incidence of postoperative metatarsalgia and returned to their normal activities faster, thus giving a higher satisfaction rate.

Introduction: We present the long term results in 204 cases of Hallux Valgus deformity correction using a modified Mitchell’s osteotomy.

Methods: 168 patients (204 feet) that had Mitchell’s osteotomies between 1986 and 2001 were recalled for clinical and radiological evaluation. The patients had hallux valgus angles of up to 50o and intermetatarsal angles of up to 20o. They all had a modified procedure using two crossed Kirschner wires to fix the capital fragment into plantar displacement and angulation. Lateral soft tissue release was performed when deemed necessary during the procedure. Mild to moderate arthritis of the 1st metatarsophalangeal joint was not a contraindication. The AOFAS scores as well as any complications were recorded and the Xrays were used to measure hallux valgus and intermetatarsal angles. Mann-Whitney U test was used to analyze data.

Results: The mean follow up was 12.9 years. The mean AOFAS score improved from a preoperative of 49.6 to a postoperative of 87.9 points (p=0.004), due to improvement in the pain (14.2 Vs 37.6, p=0.001) and function (30.6 Vs 39.8, p=0.043) parameters. 57 cases (27.9%) had Hallux Valgus angles > 40o. Lateral soft tissue release was performed in only 16 of these cases with no significant difference in the postoperative Hallux Valgus angle compared to the ones not requiring soft tissue release (21.3o Vs 20.8o, p=0.08). There was a decrease in the pre-operative Vs post-operative incidence of lateral metatarsalgia and symptomatic callosities (18.33% Vs 11.8%, p=0.023). We had only one case of avascular necrosis.

Discussion/Conclusion: Mitchell’s osteotomy is a reliable technique with successful outcomes and minimal complications when performed with accurate surgical technique, stable fixation and lateral soft tissue release when appropriate. It may also be successfully performed for Hallux Valgus angles > 40o. We believe that it has still got a role in the treatment of Hallux Valgus.

Purpose: This study was performed to evaluate the results of intramedullary nailing of distal tibial fractures located within 5 cm of the ankle joint.

Materials and Method: From 1990 to 2007, 142 tibial fractures that involved the distal 5 cm of the tibia were treated with reamed intramedullary nailing with use of either two or three distal interlocking screws. Twenty-one tibial fractures were open and were treated primarily with external fixation and then with intramedullary nailing.

Seventy patients (49%) were under 20 years old, 85 (59%) were men and traffic accident was the main cause of fracture in 58 (41%) patients.

108 patients were treated with GK nail, 14 patients with modified GK nail and 20 patients with S2 nail.

All patients were allowed postoperatively full weight bearing with crutches till the fracture healing. Patients were evaluated clinically and radiographs were reviewed every three weeks till fracture healing. Last follow-up was at two years postoperatively.

The functional results were evaluated with the Iowa Ankle-Evaluating System.

Results: Acceptable radiographic alignment, defined as < 5° of angulation in any plane, was obtained in 135 patients (95%). No patient had any change in alignment between the immediate postoperative and the final radiographic evaluation. We had no non-unions or failures of the implant.

Complications included one superficial infection at the entry point of the nail and one iatrogenic fracture at the time of the intramedullary nailing. The fractures united at an average of 12.5 weeks.

The functional outcome was determined at one and two years postoperatively.

There was improvement in the Iowa Ankle-Evaluating System scores with time.

Conclusion: Intramedullary nailing is an effective alternative for the treatment of distal metaphyseal tibial fractures. Simple articular extension of the fracture is not a contraindication to intramedullary fixation. Functional outcomes improve with time.