Medial Displacement Osteotomy (MDO) of the os calcis is used to correct the hind foot valgus in a flat foot deformity. Screw fixation is commonly used although contemporary locking plate systems are now available. This study tested the hypothesis that a 10mm MDO would support a higher load to failure with a locked step plate than with a single cannulated screw.

A 16-year-old professional female ballet student sustained a plantar flexion-inversion injury to her left ankle while dancing. Clinical examination and MRI suggested subluxation of the tibiotalar joint. However, accurate diagnosis was hampered by a transient palsy of the common peroneal nerve. It was subsequently established that she had also sustained a dislocation of her calcaneocuboid joint, a rare injury, which was successfully stabilised by using a hamstring graft. The presentation and management of this rare condition are discussed.

Although the use of split tibialis anterior tendon transfer (combined with the Rose calcaneal osteotomy and reinforcement of the spring ligament) is a recognised procedure in the treatment of stage II tibialis posterior dysfunction, there is a paucity of data regarding its results. Forty-three patients who underwent reconstruction between 1997 and 2003 were evaluated pre- and postoperatively using the AHS scoring system. The average age was 57, and the mean follow-up time was 51 months (range 10–83).

The average AHS score pre-op. was 58 and post-op. was 85. Sixty-six per cent of patients achieved single heel raise. Eighty-four per cent expressed a subjective satisfaction rate, whilst 16% had no improvement. Seventy-eight per cent were able to use normal shoes and 58% did not require the use of any orthotics. The minor complication rate was 16% with no major complications. All osteotomies united uneventfully. Two patients have developed subtalar osteoarthritis, and six calcaneal screws had to be removed for prominence and tenderness.

Our results compare very favourably with other less anatomical reconstructions, but without the donor site morbidity and very low complication rates. A subjective satisfaction rate of 84% has been achieved.

31 cases of high-energy proximal tibial fractures were retrospectively analysed. The series included 22 cases of Schatzker VI and 9 cases of proximal tibial extraarticular fractures There were 7 females and 24 males, with average age being 45 years (26–94). There were 12 open fractures (1 Gustilo grade1, 10 grade 3b and one 3c); while 19 cases had Tcherne’s grade 2–3 injury. 4 patients developed compartment syndromes requiring fasciotomy. All fractures were treated with preliminary ligamentotaxis using a unilateral external fixator. In addition, open fractures underwent radical debridement with the one case of 3c requiring vascular reconstruction. CT scan was then done to assess the joint incongruity, anatomy of the fracture, and to aid in decision making. The fractures were then fixed using percutaneous technique and a circular external fixator. Minimal open reduction was resorted to in cases with significant joint depression. In all, 26 cases were managed using percutaneous techniques alone while 5 require minimal open reduction and screw fixation. Bone grafting was done in 6 cases and 11 required a plastics procedure for soft tissue reconstruction. The results were assessed using the radiological Rasmussen’s criteria and the clinically using the IKSS knee score. At a mean follow-up of 31mths, the mean time to metaphyseal union was 18 weeks (6–25 weeks); 28 patients had good to excellent clinical scores, while 3 had a fair result. The radiologic assessment graded 12 cases as excellent and 19 as good. Complications included 2 cases with flap edge necrosis, 2 with severe pin tract sepsis, 1 with proximal DVT and one case with septic arthritis.

We conclude that the above treatment protocol yields promising results, preserving good knee function without prejudicing future need for arthroplasty.