Introduction: We present a modification of surgical technique of Mitchell’s Osteotomy for hallux Valgus and the follow-up results in a consecutive series of patients operated by a single surgeon using this technique.

The modification involves: 1/not using any form of fixation of the osteotomy – neither a bone suture nor any k wires or pins. 2/a capsulodesis was preformed to correct the Hallux Valgus deformity by suturing the capsule to the distal metatarsal shaft using vicryl through 2mm drill hole.

Patients and Methods: Ninety nine patients operated on, 54 patients were seen in the clinics, 26 answered telephone questionnaire and 19 patients were unable to attend. The 54 patients who attended the clinics were examined and roentgenograms of the feet were taken. AOFAS forefoot score was used to assess the outcome.

Results: Of the 54 patients seen, 29 patients scored > 90 (AOFAS), 17 patients scored between 80 to 90 points in AOFAS and 8 patients scored < 80 points. Of the patients who answered the questionnaire, 22 patients were satisfied with the surgery and four had minor discomfort during activity. Three patients had secondary surgery for transfer metatarsalgia /hammer toes. On statistical analysis, there was no correlation between the outcome and factors such as age, degree of deformity and the post operative shortening of the first ray.

Discussion: Our surgical technique did not result in any acute instability of the osteotomy. There was no evidence of any symptomatic stiffness of the metatarsophalangeal joint because of capsulodesis.

Introduction: We report a prospective study of the effect of body mass index and the length of the tourniquet time on the blood loss in total knee replacement in 70 consecutive patients.

Methods and materials: The patients’ weight and height were recorded to establish the body mass index (BMI). The patients were classified into four groups according to their BMI. The blood loss both intra-operative and post-operative was recorded. In addition, the tourniquet time was recorded.

Results: No significant increase in blood loss was demonstrated in patients with a high BMI, and there was no significant increase in the blood loss with longer tourniquet times.

Conclusion: Obesity does not increase the overall bleeding in total knee replacement.

Introduction: We present the results of a prospective randomized trial of Zadik’s procedure V. chemical ablation by sodium hydroxide for the treatment of ingrowing toenails.

Materials and Methods: Thirty eight patients had Zadik’s procedure, 45 patients had chemical ablation by sodium hydroxide. Mean average follow-up was 12.45 months for Zadik’s group and 11.69 months for the chemical group.

Results: We have studied 5 end points: 1/return to normal shoe wear. In Zadik’s group, the average return to normal shoe wear was 2.13 weeks and 3.73 weeks in the chemical group. 2/average return to normal activity was 2.18 weeks for Zadik’s group and 3.89 for the chemical group. 3/the median numbers of dressings were 3 and 8 for Zadik’s and chemical ablation patients respectively. 4/the pain score, using the visual analogue, were not statistically significant between the two groups. 5/the recurrence rate, 23 recurrences in Zadik’s group (60.5%) and seven recurrences in chemical ablation group (15.6%). However, only 13 patients had symptomatic recurrence (34.2%) in the Zadik group and two patients had recurrence in the chemical ablation group (4.4%). 6/economic implications are considerable if we to compare the surgical ablation against the much cheaper chemical ablation.

Conclusion: The use of chemical ablation by sodium hydroxide in the treatment of ingrowing toenails shows statistically significant reduction in the recurrence rate of ingrowing toenails compared to Zadik’s procedure (P< 0.05).

Introduction: We present the results of a prospective randomized trial of Zadik’s procedure V. chemical ablation by sodium hydroxide for the treatment of ingrowing toenails.

Materials and Methods: Thirty eight patients had Zadik’s procedure, 45 patients had chemical ablation by sodium hydroxide. Mean average follow-up was 12.45 months for Zadik’s group and 11.69 months for the chemical group.

Results: We have studied 5 end points: 1/return to normal shoe wear. In Zadik’s group, the average return to normal shoe wear was 2.13 weeks and 3.73 weeks in the chemical group. 2/average return to normal activity was 2.18 weeks for Zadik’s group and 3.89 for the chemical group. 3/the median numbers of dressings were 3 and 8 for Zadik’s and chemical ablation patients respectively. 4/the pain score, using the visual analogue, were not statistically significant between the two groups. 5/the recurrence rate, 23 recurrences in Zadik’s group (60.5%) and seven recurrences in chemical ablation group (15.6%). However, only 13 patients had symptomatic recurrence (34.2%) in the Zadik group and two patients had recurrence in the chemical ablation group (4.4%).

Conclusion: The use of chemical ablation by sodium hydroxide in the treatment of ingrowing toenails shows statistically significant reduction in the recurrence rate of ingrowing toenails compared to Zadik’s procedure (P< 0.05). Key words: Ingrowing toe nails, Zadik’s, Chemical ablation.