Triple arthrodesis is the most effective treatment resource for restoring shape and stability to the hind-foot. It is used in order to achieve a plantigrade foot, aligned, stable and painless, in the treatment of various pathologies. However, it has the effect of changing the dynamic mobility of the foot and diminishes the adapting ability to uneven ground, influencing the outcome. Opinions differ on the necessity of internal fixation to maintain the proper alignment of the hind-foot and improve consolidation, influencing the results.

The authors reviewed the patients who underwent triple arthrodesis between 01/01/1998 and 31/12/2008. Of a total of 46 patients 28 were reviewed, corresponding to 29 feet that underwent 36 interventions (7 recurrences).

Patients were divided into two groups according to whether or not the placement of internal fixation. They were evaluated according to the AOFAS ankle and hindfoot score and correlated with the radiologic result.

The most frequent indications for surgery were osteoarthrosis of the tarsus and sequelae of fractures of the calcaneus.

In the group without fixation 68% had radiological signs of consolidation. 24% required revision for non consolidation. In the group with internal fixation there was 72.7% consolidation and 9.1% required revision surgery. Bone graft was more often used in internal fixation group (72.7% vs 40%).

Group without fixation vs group with internal fixation:

AOFAS mean score: 74.5% vs 61.6%, patients without pain: 50% vs 20%; plantigrade foot with good alignment: 66.7% vs 40% without pain: 50% vs 20%; tibiotarsal arthritis: 48% vs 63.6%; Lisfranc arthrosis: 44% vs 63.6%.

There is a higher rate of consolidation in the group setting. However, the functional outcome seems to be better in the group without fixation.

Fixation seems to be associated with better consolidation. The functional outcome is related to a plantigrade and well aligned foot.

Introduction

The sliding hip screw is the implant of choice for the operative treatment of stable trochanteric femur fractures. Surgeons have been using widely the four-hole side plate DHS (Dynamic Hip screw) with four bicortical screws, which allows adequate weight bearing after operation. However, there is lacking of scientific studies that support the use of such long plate and we question ourselves if we can accomplish the same results with the use of a smaller plate. The objective of this study is to compare the results accomplished with a four-hole and a two-hole DHS side plate in the treatment of transtrochanteric fractures.

It appears that double bundle anterior cruciate ligament reconstruction can reproduce the original anatomy of the ligament, restoring normal kinematics and rotational control of the tibia. But an anatomical single bundle reconstruction may present very similar results, with minor technical difficulties and lower costs.

We compared two groups of 25 patients each, that underwent ACL reconstruction by the same surgeon, with a follow-up of 12–36 months. One group had double bundle reconstruction with hamstring and the other had single bundle anatomical reconstruction with patellar tendon.

Patients underwent a subjective evaluation and clinical testing with instrumented laxity with Rolimeter, and the data entered in the IKDC 2000 scale Double tunnel hamstring Vs bone-tendon-bone: Functional outcome of 85.6% Global Class A and B vs. 82.1% Class A and B. The subjective outcome (IKDC 2000) was 90.93 vs. 91.47. Pivot-shift test with 87% patients in class A and class B at 9.7% Vs 75% patients in class A, 21.4% for class B. The Rolimeter gave an average Lachman value of 2,56 and anterior drawer test of 2,88 Vs average Lachman value of 3.59 and anterior drawer test of 2.92. One leg hop test showed 85.7% knees class A, 9.5% knees class B vs. 90.4% knees class A and, 2.8% knees class B.

The subjective score was slightly higher in the single bundle anatomical reconstruction with patellar tendon, despite the overall functional outcome being higher in the double tunnel technique with hamstrings. The average Lachmann in the patellar tendon group was 1 mm higher. The rotational stability in the double tunnel was higher.

The same surgeon had better results in the double tunnel hamstrings technique, despite less experienced with this technique, which is more demanding, probably reflecting objective advantages over the single bundle reconstruction with patellar tendon

The median nerve compression in the carpal tunnel is the most common compression syndrome of the upper limb. In most cases it is idiopathic but may also occur from anatomical, traumatic, endocrine, rheumatic or tumoral causes.

Chow's endoscopic technique was initially used to treat this disease and then modified to a mini-open approach through a single palmar incision. This incision is similar to the one used in endoscopic release by Agee. After exposing the proximal part of the transverse carpal ligament a meniscus knife is advanced until there is a complete section of the ligament, without endoscopic equipment.

Between 2004 and 2006, 200 hands in 179 patients with a diagnosis based on clinical and electromyographic criteria were operated by this mini-open technique. The mean follow-up was 49 months (minimum of 34 months and a maximum of 70 months).

50 randomly selected patients were submitted to the self-administered Boston questionnaire. 50 patients treated by the minimal-incision decompression during the same period were also given the questionnaire. The aesthetic satisfaction was registered as well as if they would have surgery on the other hand or would recommend the procedure.

This mini-open technique is another technique available to the surgeon that allows very similar functional results to endoscopic surgery, without use of specific material and with a shorter surgical time.