Lateral ligament reconstruction of the ankle for chronic symptomatic mechanical instability is a relatively common procedure for Foot and Ankle surgeons to undertake. The following method has been undertaken by the Senior Author for the past ten years.
We studied 26 patients (26 feet). The average age was 32 years with 16 males and 10 females. Duration of follow up was from 11 months to 11 years.
Functional instability and alternative diagnoses such as tendonopathy and previously unrecognised fractures were excluded, sometimes by extensive investigations. All patients undergoing surgery had a period of conservative treatment which had failed. Stress radiographs confirmed instability in two planes and was either undertaken preoperatively or just prior to surgery under anaesthesia.
Through a small oblique lateral incision, the lateral capsule, ligaments and periosteum were advanced over the tip of the fibula in a proximal and posterior direction and re-anchored tightly to the bone, usually with Mitek (titanium) bone anchors.
The patients were casted for six weeks whilst weight bearing, followed by six weeks of physiotherapy.
The success rate was over 85%. The complications were scar tenderness, recurrent instability and ankle spurring. There were no complications caused by the metallic anchors.
This procedure has a comparable success rate with similar anatomical ligament reconstructive procedures and can be recommended.
In a retrospective study we compared the results of 31 Wilson and 31 Hohmann osteotomies of the first metatarsal in the treatment of hallux valgus. There were no differences between the two operations in terms of patient satisfaction, pain relief, appearance, footwear and walking ability. First metatarsal shortening was the same after both operations, and the degree of shortening was unrelated to either the clinical or the pedobarographic findings. Although the long-term radiographic changes after the Hohmann osteotomy were more worrying, the pedobarographic patterns tended to be worse after the Wilson osteotomy. There were no poor results and the numbers of feet with the same final grade were identical in each group. However, there was abnormal loading of the lateral metatarsal heads after both osteotomies when compared with the normal foot, and hallux-contact time during the stance phase was also significantly reduced after osteotomy.
Three cases of a rare complication of Salter Type II fracture-separations of the distal tibial epiphysis are described. Interposition of the anterior tibial neurovascular bundle between the displaced epiphysis and the lower tibia prevented reduction and, in two patients, the blood supply to the foot was compromised. Open reduction and internal fixation resulted in a satisfactory outcome in each case.
Fracture separation of the capital femoral epiphysis occurring during attempted closed reduction of a traumatic dislocation of the hip is described in two adolescents. Although this complication is extremely rare, the prognosis of fracture separation with dislocation of the epiphysis is known to be poor. Avascular necrosis subsequently developed in both cases. The importance of gentle manipulative reduction under general anaesthesia with complete muscle relaxation is emphasised.
