The Weil osteotomy has gained popularity for surgically treating patients with metatarsalgia, intractable plantar keratosis and/or metatarsophalangeal joint dislocation because of its simplicity and lack of complications. Different geometric configurations of the Weil osteotomy have been proposed to reduce plantar pressure. In a dynamic cadaver model, these different geometric configurations of the Weil osteotomy did not significantly alter plantar pressure. Metatarsal head resection was required to significantly reduce plantar pressure.

The purpose of this study was to evaluate the effect of different geometric configurations of the Weil osteotomy on the plantar pressures in a dynamic cadaver model.

Different geometric configurations of the Weil osteotomy have been proposed to decrease plantar pressure, but in a dynamic cadaver model, these modifications did not significantly alter plantar pressure. Metatarsal head resection was required to significantly reduce plantar pressure.

The plantar translation of the metatarsal head occurring with a more oblique Weil osteotomy compared to a standard Weil osteotomy did not significantly increase plantar pressure in a dynamic cadaver model. The addition of a 4 mm slice resection did not significantly reduce pressure. Metatarsal head resection was required to significantly reduce pressure (p=0.02).

Ten specimens (5 matched pairs of cadaver lower extremities) were tested. Each pair of specimens had an oblique Weil osteotomy performed on one side, and a standard (parallel) Weil osteotomy on the other. Then, a 4 mm slice resection, and metatarsal head resection were performed sequentially. The plantar pressures were measured with an F scan in-shoe sensor while cyclically loaded to 700 N at a frequency of 1 Hz in intact specimens, and after each intervention.

The different geometric configurations of the Weil osteotomy did not significantly alter plantar pressure; metatarsal head resection was required to significantly reduce pressure. The Weil osteotomy reliably reduces dislocated metatarsophalangeal joints. The angle of the osteotomy does not affect plantar pressure. Further study in a dynamic model is required to identify other factors, which affect plantar pressure.

Aims: To evaluate the outcome of our consecutive series of patients who underwent revision surgery due to unresolved or recurrent symptoms after an initial procedure or procedures for interdigital neuroma excision. Methods: In a six year period 49 patients underwent revision neuroma surgery utilizing a dorsal approach. Sixty interspaces were re-explored. In addition, ten patients underwent primary neuroma resection from an adjacent interspace, while 19 patients underwent concomitant forefoot surgery. Results: The average duration of postoperative follow-up was 39.7 months. Fifteen patients (30.7%) were completely satis-þed, thirteen (26.5%) satisþed with minor reservations, ten (20.4%) satisþed with major reservations and eleven (22.4%) dissatisþed with the postoperative outcome. The exploration of two adjacent interspaces, the intraopera-tive þndings, the concomitant forefoot surgery and the previous attempts at re-exploration had an inßuence on the þnal outcome. Seven patients (14.3%) had no footwear restrictions, thirteen patients (26.5%) had mild, twenty-one (42.9%) had moderate and eight (16.3%) severe footwear restrictions. Nineteen patients (38.8%) had no activity restrictions, twenty-two (44.9%) had mild, eight (16.3%) moderate and none reported severe restrictions interfering with daily activities. Conclusions: Persistent or recurrent symptoms after nerve transection present a challenging problem for both the surgeon and the patient. Thorough preoperative discussion must be undertaken with the patient, providing the average rates of failure and the increased likelihood of footwear and activity restrictions.

Aims: The purposes of the current retrospective study were to evaluate the outcome of a consecutive series of supramalleolar osteotomies and to identify the inßu-ence of the technique (opening versus closing wedge) on the outcome and the union rate. Methods: In a þve year period, we performed a supramalleolar osteotomy for the correction of distal tibial mechanical malalign-ment of at least 10¡, with concomitant pain and with or without radiographic evidence of arthritic changes, or as an alternative to other common procedures, for the treatment of a small group of patients with degenerative changes of the ankle joint. Results: There were 14 patients (15 feet) with an average follow up of 31.1 months. All osteotomies healed at an average time of 13.6 weeks. The average AOFAS score improved from 53.8 to 87 points, the average Takakura score from 56.7 to 82 and the average pain score from 13.5 to 31.4. In the presence of deformity the average values of TAS and TLS angles were signiþcantly improved. The radiographic degenerative changes in the ankle joint showed no evidence of progression. The choice of technique did not inßuence the clinical- radiographic outcome and the healing time of the osteotomy. Conclusions: Supramalleolar osteotomy is a useful procedure to: a. reconstruct the normal mechanical environment in malunion preventing or decelerating any long term deleterious effects and improving pain and function levels, and b. to shift and redistribute loads in the ankle joint in an effort to protect the articular cartilage from further degenerative process.

Aims: The objective of our study is to elucidate the chondrogenic potential of free autologous periosteal grafts in treating articular cartilage defects, especially in complicated cases where apart from the cartilage defect there are coexisting lesions. Methods: 60 young rabbits were randomly divided in 5 groups. A cartilage defect 0.5 ⋄ 0.5 was created in both knees of each rabbit and covered with free autologous periosteal graft. In the right knee an additional ligamentous lesion was created. Results: All the knees were amputated at one, two and three months postoperatively. Apart from the histological examination, the cartilage specimens were tested biomechanically. An indentation test was used using a Shore A sclerometer and the data were evaluated and compared. In the test group the produced fibrocartilage or hyaline-like cartilage, was mechanically inferior (hardness 50–70 GPa) comparing to the control knees group (98 GPa). The results were statistically evaluated (using O’Driscoll’s histological grading scale and Wilcoxon rank sum test). Conclusions: Autologous periosteal transplantation can be used in daily practise, as it is a method relatively easy to perform with low cost and without any contra-indications. Nevertheless, in cases of unstable knees the method has poor results and ligamentous repair is recommended first.

Aims: To evaluate the effect of different geometric conþgurations of the Weil osteotomy on the plantar pressures in a dynamic in vitro cadaver model. Methods: Ten specimens consisting of 5 matched pairs of cadaver lower extremities were tested. Each pair of specimens had an oblique Weil osteotomy with 5 mm shift performed on one side, and a standard (parallel) Weil osteotomy with 5 mm shift on the other. Then, a 4 mm slice resection, and metatarsal head resection were performed sequentially on each specimen. The plantar pressures were measured while cyclically loaded to 700 N at a frequency of 1 Hz with a F scan in-shoe sensor in intact specimens, and after each intervention. Results: This is the þrst study to demonstrate that the plantar translation of the metatarsal head occurring with a more oblique Weil osteotomy compared to a standard (parallel) Weil osteotomy did not signiþcantly increase plantar pressure in a dynamic in vitro cadaver model. Furthermore, the addition of a 4 mm slice resection did not signiþcantly unload the metatarsal head. Metatarsal head resection was required to signiþcantly unload the metatarsal head (p=0.02). Conclusions: The different geometric conþgurations of the Weil osteotomy did not signiþcantly alter plantar pressures in a dynamic cadaver model. Metatarsal head resection was required to signiþcantly unload the metatarsal head. Future studies of the effect of metatarsal osteotomies on plantar pressure should include evaluation in a dynamic in vitrocadaver model to account for all factors, which determine the distribution of plantar pressure.

Aims: To present the treatment method and outcome of þve cases of type IV coronal shear fractures of the distal end of the humerus. Methods: In a two year period, þve patients with an isolated type IV coronal shear fracture of the distal end of the humerus underwent open reduction and internal þxation of the fractures utilizing Herbert screws, through a modiþed extensile lateral Kocher approach. The main outcome measurements were: Functional elbow index rating scale of Broberg- Morrey, Mayo Elbow Performance Score, subjective satisfaction rate and subjective functional limitations, and radiographic evaluation. Results: The follow-up time ranged from thirty nine to þfty months. All fractures healed within a range of six to nine weeks. The latest radiographic evaluation revealed mild degenerative joint disease changes in one patient and osteonecrosis of the coronal shear fragment in another. None of the patients reported pain even during strenuous activities, and none had clinical þndings or subjective complaints suggesting instability of the elbow joint. Four patients regained full range of elbow motion as compared with the contralateral elbow, and only one had a 10û extension lag. No patient reported limitations in activities, and all indicated complete satisfaction with their outcome. According to the Broberg Morrey Scale and the Mayo Elbow Performance Score, all results were excellent, with the scores ranged from 98 to 100 points. Conclusions: Recognition of this particular type of injury, prompt treatment with anatomic reduction and internal þxation, and early rehabilitation can lead to excellent functional outcomes.

Aims: The purposes of the current retrospective study were to evaluate the outcome of a consecutive series of supramalleolar osteotomies and to identify the influence of the technique (opening versus closing wedge) on the outcome and the union rate.

Methods: In a five year period, we performed a supra-malleolar osteotomy for the correction of distal tibial mechanical malalignment of at least 10°, with concomitant pain and with or without radiographic evidence of arthritic changes, or as an alternative to other common procedures, for the treatment of a small group of patients with degenerative changes of the ankle joint.

Results: There were 14 patients (15 feet) with an average follow up of 31.1 months. All osteotomies healed at an average time of 13.6 weeks. The average AOFAS score improved from 53.8 to 87 points, the average Takakura score from 56.7 to 82 and the average pain score from 13.5 to 31.4. In the presence of deformity the average values of TAS and TLS angles were significantly improved. The radiographic degenerative changes in the ankle joint showed no evidence of progression. The choice of technique did not influence the clinical- radiographic outcome and the healing time of the osteotomy.

Conclusions: Supramalleolar osteotomy is a useful procedure to: a. reconstruct the normal mechanical environment in malunion preventing or decelerating any long term deleterious effects and improving pain and function levels, and b. to shift and redistribute loads in the ankle joint in an effort to protect the articular cartilage from further degenerative process.

Aims: To evaluate the outcome of our consecutive series of patients who underwent revision surgery due to unresolved or recurrent symptoms after an initial procedure or procedures for interdigital neuroma excision.

Methods: In a six year period 49 patients underwent revision neuroma surgery utilizing a dorsal approach. Sixty interspaces were re-explored. In addition, ten patients underwent primary neuroma resection from an adjacent interspace, while 19 patients underwent concomitant forefoot surgery.

Results: The average duration of postoperative follow-up was 39.7 months. Fifteen patients (30.7%) were completely satisfied, thirteen (26.5%) satisfied with minor reservations, ten (20.4%) satisfied with major reservations and eleven (22.4%) dissatisfied with the postoperative outcome. The exploration of two adjacent interspaces, the intraoperative findings, the concomitant forefoot surgery and the previous attempts at re-exploration had an influence on the final outcome. Seven patients (14.3%) had no footwear restrictions, thirteen patients (26.5%) had mild, twenty-one (42.9%) had moderate and eight (16.3%) severe footwear restrictions. Nineteen patients (38.8%) had no activity restrictions, twenty-two (44.9%) had mild, eight (16.3%) moderate and none reported severe restrictions interfering with daily activities.

Conclusions: Persistent or recurrent symptoms after nerve transection present a challenging problem for both the surgeon and the patient. Thorough preoperative discussion must be undertaken with the patient, providing the average rates of failure and the increased likelihood of footwear and activity restrictions.

Aims: To present the treatment method and outcome of five cases of type IV coronal shear fractures of the distal end of the humerus.

Methods: In a two year period, five patients with an isolated type IV coronal shear fracture of the distal end of the humerus underwent open reduction and internal fixation of the fractures utilizing Herbert screws, through a modified extensile lateral Kocher approach. The main outcome measurements were: Functional elbow index rating scale of Broberg- Morrey, Mayo Elbow Performance Score, subjective satisfaction rate and subjective functional limitations, and radiographic evaluation.

Results: The follow-up time ranged from thirty nine to fifty months. All fractures healed within a range of six to nine weeks. The latest radiographic evaluation revealed mild degenerative joint disease changes in one patient and osteonecrosis of the coronal shear fragment in another. None of the patients reported pain even during strenuous activities, and none had clinical findings or subjective complaints suggesting instability of the elbow joint. Four patients regained full range of elbow motion as compared with the contralateral elbow, and only one had a 10° extension lag. No patient reported limitations in activities, and all indicated complete satisfaction with their outcome. According to the Broberg Morrey Scale and the Mayo Elbow Performance Score, all results were excellent, with the scores ranged from 98 to 100 points.

Conclusions: Recognition of this particular type of injury, prompt treatment with anatomic reduction and internal fixation, and early rehabilitation can lead to excellent functional outcomes.