Short scarf osteotomy (SSO) retains the versatility of standard scarf in treating moderate and severe hallux valgus deformity with the added benefit of less invasiveness translated into less soft-tissue stripping, reduced exposure, less metalwork, less operative time and reduced cost. We present our medium-term clinical, radiographic and patient satisfaction results.

All patients who underwent SSO between January 2015 and December 2017 were eligible (98). Exclusion criteria were: follow up less than a year, additional 1st ray procedures, inflammatory arthropathy, infection, peripheral vascular disease and hallux rigidus. Eighty-four patients (94 feet) were included: 80 females / 4 males with average age of 51-year-old (24–81). Minimum follow up was 12 months (12–28). Weight-bearing x-rays and AOFAS score were compared pre- and postoperatively. Non-parametric Mann-Whitney U test assessed statistical significance of our results.

Hallux valgus angle (HVA) improved from preoperative mean of 30.8° (17.4°–46.8°) to 12° (4°–30°) postoperatively (p=0.0001). Intermetatarsal angle (IMA) improved from preoperative mean of 15.1° (10.3°–21.1°) to 7.1° (4°–15.1°) postoperatively (p=0.0001). Average sesamoid coverage according to Reynold's tibial sesamoid position improved from average grade 2.18 (1–3) to 0.57 (0–2) (p=0.0001). Average AOFAS score improved from 51.26 (32–88) to 91.1 (72–100) (p=0.0001). Ninety percent of patients were satisfied and 83% wound recommend the surgery. No troughing phenomenon or fractures. Four overcorrections were found 3 of which did not require surgery. One recurrence at 18 months was treated with standard scarf.

We believe that this technique offers a safer, quicker and equally versatile way of dealing with Hallux Valgus.

Purpose: To assess moderate-term outcomes of silastic joint replacements of the first metatarsophalangeal joint.

Method: The thirty-two patients (37 feet) that had silastic implants inserted were reviewed at an average of 2 years and 4 months (ranging 7 months to 5 years and 4 months). The mean patient age was 63 years. These patients answered a subjective questionnaire, had their feet examined clinically and radiographically and a pre-operative and post-operative AOFAS score was calculated for each.

Results: The follow-up assessment revealed that every patient described that their pain had decreased after surgery and 17 feet (46%) were completely pain free. There was a significant improvement in patients’ subjective pain scores after surgery (t value = < 0.0001). Pre-operatively, the mean pain score for all 37 feet was 8.14, whereas post-operative the mean pain score was 1.32. The mean AOFAS score before surgery was 39.97. This increased to a mean score of 87.40 after surgery (P = < 0.0001). This again is a significant improvement. No patient was dissatisfied with the outcome with their surgery.

Conclusion: These moderate term results are encouraging, with good subjective and objective results. However, long-term follow-up will be required to assess the longevity of this implant.

We present our long-term results using a modified Chrisman-Snook procedure in 12 consecutive patients over a 4 year period. The minimum follow-up was 1 year.

We used this procedure in patients with symptomatic lateral instability of the ankle, with the index injury being 5 years or more prior to surgery. We believe that poor soft tissue at the site of the ligament rupture precludes an anatomical reconstruction (8 patients). 4 patients had had a previous failed Brostrom reconstruction.

Materials and Methods: 12 patients (10 males:2 females) Age: 32–57 (average 48) All patients had a pre-surgery trial of physiotherapy, proprioceptive exercises and bracing was considered unacceptable.10 patients had pre-surgery MR scans. 10 patients underwent arthroscopy of the ankle at the time of the reconstruction.

Technique: Lateral extensile incision with dorsal half of peroneus brevis used as graft.

Suture anchor in the talus and drill tunnels in the fibula and calcaneum.

Results: AOFAS Preop: 69 (range 60–76) Postop: 92 (range 88–97)11 reported subjective stability, 1 had occasional instability with no objective corroboration. Objectively, 4 had over-tightening with loss of between 20–30% of subtalar movement. There were 2 sural nerve injuries. There were 2 minor wound complications, NOT requiring surgical intervention. All the above complications occurred in the first 6 cases.

Conclusions: We conclude that this is a powerful corrective procedure for chronic lateral ankle instability, but is technically demanding. There are complications in the form of over-tightening and nerve damage which can be minimised with experience.

Pilon fractures of the distal tibia pose a difficult therapeutic problem. Various treatment methods exist. We present encouraging early results with the Medial Tibial LISS plate (LCDCP) for these injuries.

Materials and Methods: 7 patients (5 male:2 female); age: 34 (range 26–59); All closed injuries 3 type 1; 3 type 2; 1 type IIIc; Average time from injury to surgery: 6 days (4–12 days).

Technique: 4 patients had preliminary joint-spanning fixator; 4 patients had fibular plating through a posterolateral incision; A curved anteromedial incision was used to avoid plate exposure in case of wound breakdown. Medial Tibial LISS plate with inter-fragmentary screws to reduce main fracture fragments. Early, non-weight bearing mobilization.

Results: Minimum Follow Up: 6 months (range 6–18 months). Union was obtained in all fractures. Joint reconstruction was graded as anatomical in 3 patients, mildly non-anatomical in 3 patients, and markedly incongruent in 1 patient (Type IIIc3). ROM: average 10° Dorsiflexion and 30° Plantarflexion. Pain: None in 4, mild in 2, and severe in 1. Wound healing problems: 1 minor requiring no surgical intervention, 1 requiring debridement of distal tibial wound.

We conclude that this technique offers a viable alternative to other methods in the treatment of these difficult injuries.

Chronic ruptures of the tendo-achilles in young individuals pose difficult therapeutic problems. Surgical repair Is necessary to achieve optimum functional results. We present our results using a modified Bosworth technique using a ‘turn-down’ strip of gastrosoleus aponeurosis

Materials and methods: 11 patients (9 Males:2 Females) Age range: 23–51 (average 36) Time since rupture: 9–20 weeks (average 13). All had pain, weak or absent push-off and restricted ADL.

Technique: Posterior midline incision – rupture exposed, ends debrided – 1” strip of gastrosoleus aponeurosis about 2–3” long – detatched proximally ‘turned down’ with fascial surface anterior. This modification was to avoid tissue bulge at proximal end of incision. The fascial strip was approximated with delayed absorbable sutures. The plantaris was used to supplement the repair when possible.

Cast-bracing for 9 weeks. FU – 12–42 months, minimum 12. All patients independently assessed at one year. AOFAS hindfoot scores – Preop and 1 year postop

Results: AOFAS scores: Preop: 49 (40–61) Postop: 82(70–94) 2 minor wound problems-no surgical intervention required. Push-off strength returned to about 70–80% in all patients. 7/11 patients returned to preop recreational activities.

We conclude that this is a safe and predictable repair technique in this group of patients. It is technically easy, restores tendon length and provides excellent functional improvement.