TMTJ fusion is performed for arthritis or painful deformity. K-wire and trans-articular screws are usually used to stabilize the joints. We present our experience with LP for TMTJ fusion in first 100 joints. Patients and methods. 100 TMTJ in 74 patients were fused and stabilised with LP between January 2007 and December 2010. The indication was Lisfranc arthritis and hallux valgus. Iliac crest bone autograft was used in 64 joints. Auto graft was used in 22/53 first TMT fusions. All patients post-operatively had below knee plaster immobilization and protected weight bearing walking for first 6 weeks. Clinical and radiological surveillance continued until bone. AOFAS midfoot scale was used as outcome measure. Results. There were 18 male and 56 female patients with average age of 51 (14 -68). AOFAS midfoot scale improved 42% for pain, 30% for function and 53% for alignment. Average AOFAS overall score improved from 30 pre-op to 67 post op. 95 joints had clinical and radiological fusion. 1 patient needed removal of metalwork and 3 had delayed wound healing and 4 had radiological non- . All non- s were in 1st TMTJ where bone graft failed and were revised. None of the lesser ray TMTJ had non- . Average satisfaction score was 7 out of 10. 86% said they would recommend it to a friend and 91% would have it again. Discussion. Biomechanical studies has shown plates are not as strong or stiff as trans-articular screw fixation however they are easy to use, have more flexibility and act as a buttress for autograft. Our results show that dorsal locking plate has satisfactory clinical out come with or without bone graft for lesser rays. 1st TMT fusion without bone graft has higher fusion rate compare to 3 failures in 22 1st TMTJ with bone graft. This is due to multiple factors including LP being not strong enough to sustain the stresses until creeping substitution through the bone graft. Conclusion. Locking plates provide satisfactory stability without complications for lesser ray with or without bone graft. Fusion for 1st TMTJ with auto bone graft has high failure of 13%

Introduction. Comminuted mid-foot fractures are uncommon. Maintenance of the length and alignment of the medial column, with restoration of articular surface congruity, is associated with improved outcomes. Conventional surgery has utilised open or closed reduction with K-wire fixation, percutaneous techniques, ORIF, external fixation or a combination of these methods. In 2003 temporary bridge plating of the medial column was described to reconstruct and stabilise the medial column. The added advantage of locking plates is the use of angle-stable fixation. We present our experience with temporary locking plates in complex mid-foot fractures. Materials and methods. Prospective audit database of 12 patients over a 6 year period (2003-2009). 5 males 7 females mean age 41.9. Mechanism of injury: 11 high-energy injuries (6 falls from height, 5 RTCs), 1 low energy injury. Fracture type: All involved the medial column - 12 fracture dislocations of the medial column. 4 concomitant injuries to the lateral column. All underwent ORIF, realignment, and stabilisation with locking plates across the mid-foot. Results. Median length of time to plate removal: 3 months (range 2-6). Prior to removal of the metalwork, there was no loss of reduction, no infections, and no implant breakage. 10 out of 12 required plate removal at 3 months. Long-term follow-up (Mean 12.4 months, range 4-32): 11 have minimal symptoms of swelling or discomfort from the midfoot which does not restrict their ADLs, whilst 1 patient developed post-traumatic arthritis with medial arch collapse. No secondary procedures following plate removal. The two patients with the plate in-situ were asymptomatic with regards to the metalwork at final follow-up. Conclusion. Locking plates provide adequate stabilisation following open reduction and internal fixation of complex and unstable midfoot fracture dislocations. However, the majority will require removal of the metalwork. Following removal of the metalwork, satisfactory length and alignment, and stability of the midfoot, is maintained

Aims

Arthroplasty for end-stage hallux rigidus (HR) is controversial. Arthrodesis remains the gold standard for surgical treatment, although is not without its complications, with rates of up to 10% for nonunion, 14% for reoperation and 10% for metatarsalgia. The aim of this study was to analyze the outcome of a double-stemmed silastic implant (Wright-Medical, Memphis, Tennessee, USA) for patients with end-stage HR.