Purpose of the study: We reviewed traumatic distal leg amputations managed in our unit between 1990 and 1993. Reimplantation or unilateral emergency revascularization were undertaken in five cases.

Material and methods: The initial loss of length was considerable (range 8.5–12 cm) allowing direct internal fixation, protected with an external fixator bridging the ankle, and direct vasculonervous suture. Secondary lengthening was undertaken early in the proximal metaphyseal zone before sensorial recovery was complete.

Results: Healing was achieved within a normal delay in all cases. Nerve regeneration was monitored from the site of the microsuture by following the progression of the Tinel sign along the repaired nerve trunks; this defined the rate of regeneration. Our observations showed that nerve lengthening above the site of the microsurgical suture did not hinder nerve regeneration and even appear to stimulate it.

Conclusion: This strategy of extensive initial debridement compensated for by significant but well-tolerated secondary lengthening enabled us to broaden indications for unilateral leg reimplantations. The quality of the functional results at follow-up extending up to 15 years is probably one of the reasons justifying this strategy.

Purpose: This retrospective analysis was designed to determine the contribution of arthroscopy in the management of moderately stiff elbows arising from degenerative disease or trauma.

Material and methods: Between 1992 and 2001, we performed 31 arthroscopic examinations of the elbow in patients with moderately stiff elbows. Mean preoperative motion was 94.8°. Men age at surgery was 41.6 years; there were nine women and 22 men. The dominant side was involved in 70% of the cases. Twentyfive patients were available for clinical review at a mean 32 months follow-up (range 5 months to 9 years). The causal event was trauma in 13 cases. The stiff elbow was a consequence of degenerative disease in 13 cases with no notion of trauma. Three elbows had been exposed to repeated microtrauma. For the majority of the cases, the intervention consisted in an anterior time via two portals then a posterior time. In five cases, anterior capsulotomy was performed. The other interventions were limited to joint cleaning. For two elbows, we used the Kashiwagi Outerbridge technique. Neurolysis of the ulnar nerve was performed at the elbow level during the same operative time.

Results: Elbow motion in flexion was significantly improved after arthroscopy (P=0.01) and the flexion of the stiff elbow was reduced significantly (P=0.0001). At last follow-up none of the patients felt arthroscopy had worsened the elbow condition. The gain in joint motion was 25°. This gain was significantly greater when we performed anterior capsulotomy at the end of the procedure (P< 0.001). In three cases, there was a postoperative loss of motion. We did not have any intra or postoperative complications. Eighty percent of the patients felt arthroscopy had improved their elbow.

Discussion: Arthroscopy of the stiff elbow arising from variable causes remains a difficult intervention which in our series provided gain in motion comparable to that reported in other series in the literature. This could be an interesting less invasive alternative to open surgery in the case of moderately stiff elbow.