INTRODUCTION. Percutaneous surgery is an increasingly accepted technic for the treatment of Hallux valgus but it has some limitations when the intermetatarsal angle ismoderate to severe, having high risk of recurrence. The mini tight-rope used as a complement for precutaneous surgery avoids complications of open surgery osteotomies (delays consolidation, pain, screws protusion, infection) and it allows us continue with the recurrent trend towards minimal invasive surgery. MATERIAL AND METHOD. Between 2007 and 2009, 60 patients with severe Hallux valgus were treated in our Hospital using the percutaneous mini tight-rope. The mean age of patients was 62, 5 patients were man and 55 were woman. The mean follow-up was 18 months. RESULTS. Patients had clinical assessment using AOFAS score, radiological assessment and a subjective satisfaction degree assessment at 2,6 weeks and 4-6-12 months postoperative. As complications we found four technical failures due to learning curve, one infection and one second metatarsal fracture. CONCLUSION. mini tight-rope is a good option as a supplement in the treatment of severe hallux valgus by percutaneous technique because it avoids complications of open surgery, obtaining satisfactory results in 76% of cases according to the AOFAS scale

The collective orthopaedic literature appears to highlight the Jones fracture of the fifth metatarsal, as being slow to heal, and having a high incidence of non-union. There remains a lot of confusion, throughout the orthopaedic literature, about the exact nature of this fracture. . The authors present the largest case series currently published of 117 patients who sustained a Jones fracture, demonstrating patient outcomes with different modalities of care. All Medical notes from the Emergency Department are recorded on a database. A computer program was use to search the Emergency department database of the Edinburgh Royal infirmary notes data base for the terms 5. th. metatarsal combined with a coding for referral to fracture clinic over a 6 years period from 2004–2010. The researchers went through the X-ray archive, identified and classified all 5. th. metatarsal fractures. There were 117 patients in our series, refracture rate 7/117 6%. Average time to discharge 13 weeks (4–24). 18% of patients took longer than 18 weeks for their fracture to clinically heal. 34% were clinically healed at less than six weeks, with only 7% radiologically healed at six weeks. There was no significant difference in outcome between cast, moonboot, tubigrip or hard shoe in terms of outcome. A large proportion of Jones fractures have delayed healing, patients who are clinically asymptomatic may not have radiological healing. Currently in our practice there is no uniform management of Jones fractures. We discuss the difference in healing rates for different management techniques

Aims

Although infrequent, a fracture of the cuboid can lead to significant disruption of the integrity of the midfoot and its function. The purpose of this study was to classify the pattern of fractures of the cuboid, relate them to the mechanism of injury and suggest methods of managing them.

We carried out a retrospective review of 47 intra-articular fractures of the calcaneum treated by open reduction and internal fixation in 45 patients by a single surgeon between 1993 and 2001. The fractures were evaluated before operation by plain radiographs and a CT scan using Sanders’ classification. Osteosynthesis involved a lateral approach and the use of the AO calcaneal plate. The mean follow-up was for ten years (7 to 15). Clinical assessment included the American Orthopaedic Foot and Ankle Society Score (AOFAS), the Creighton-Nebraska Score, the Kerr, Prothero, Atkins Score and the SF-36 Health Questionnaire. The radiological evaluation consisted of lateral and axial views of the os calcis. Arthritic changes in the subtalar joint were assessed with an internal oblique view and were graded using the Morrey and Wiedeman scale.

There were 18 excellent (38.3%), 17 good (36.2%), three fair (6.3%) and nine poor (19.2%) results. Five patients had a superficial wound infection and five others eventually had a subtalar arthrodesis because of continuing pain. Restoration of Böhler’s angle was associated with a better outcome. The degree of arthritic change in the subtalar joint did not correlate with the outcome scores or Sanders’ classification. Prompt osteosynthesis should be considered for intra-articular fractures of the calcaneum in order to restore the shape of the hindfoot and Böhler’s angle.

Fracture-dislocations of the tarsometatarsal (Lisfranc) joints are frequently overlooked or misdiagnosed at initial presentation. This is a comparative cohort study over a period of five years comparing primary open reduction and internal fixation in 22 patients (23 feet) with secondary corrective arthrodesis in 22 patients (22 feet) who presented with painful malunion at a mean of 22 months (1.5 to 45) after injury. In the first group primary treatment by open reduction and internal fixation for eight weeks with Kirschner-wires or screws was undertaken, in the second group treatment was by secondary corrective arthrodesis. There was one deep infection in the first group. In the delayed group there was one complete and one partial nonunion.

In each group 20 patients were available for follow-up at a mean of 36 months (24 to 89) after operation. The mean American Orthopaedic Foot and Ankle Society midfoot score was 81.4 (62 to 100) after primary treatment and 71.8 (35 to 88) after corrective arthrodesis (t-test; p = 0.031).

We conclude that primary treatment by open reduction and internal fixation of tarsometatarsal fracture-dislocations leads to improved functional results, earlier return to work and greater patient satisfaction than secondary corrective arthrodesis, which remains a useful salvage procedure providing significant relief of pain and improvement in function.