Introduction: The AO/OTA 31 A-3 fractures are very unstable and biomechanically differ from the 31 A-1 and A-2 fractures. Recent papers state that the extra-medullary implants used to treat these fractures have a failure rate as high as 56%. Few papers report the results with intramedullary implants, and, sometimes to heal the fracture, the nails had to be dynamised by to removing the distal screw or the fracture is “self-dyna-mised” by breaking the distal screw.

Material and Methods: A prospective clinical study was designed to treat 57 consecutive patients with a 31 A-3 fracture. Mean age (84.2 years). The GT Short Nail (17-cm long, 16-mm upper diameter, and a distal locking oval hole allowing 12 mm of proximal sliding), was inserted through the apex of the greater trochanter to stabilize these fractures with a single 9-mm rotationally unlocked hip-screw, and a distal dynamically locked screw. 43 patients followed for six months were included in the study. Radiological studies: screw-tip migration (Doppelt’s method), hip-screw sliding, tip-apex distance (Baumgaertner), and proximal sliding of the distal locking screw (intra-op, one week, one month, three and six months). Full weight bearing with the needed help was encouraged as soon as possible.

Results: All fractures but one, healed uneventfully. No cutouts, no thigh pain, 1 implant failure in the only delayed healing case, and no deep infections. Three patients had further surgery to heal a bleeding skin incision. The failed implant was removed and replaced by a 90° Synthes hip plate. The average tip-screw migration was 2.4 mm, the tip-apex-distance was < than 25 mm in 94% of the cases, the average hip-screw sliding was 6.4 mm, and the average proximal sliding of the distal locking screw was 4.9 mm. In 24.5 % of the cases (14) the proximal sliding of the distal dynamically locked screw was over 10 mm.

Conclusions: A single 9-mm diameter rotationally unlocked hip screw works very well through the healing process of these very unstable fractures. A dynamically distal locked screw controls the femoral shaft rotation. Our study shows that the distal locking hole of the trochanteric nails should allow at least 10 mm of proximal sliding to provide the unknown needed proximal sliding of the distal fragment to minimize delayed or non-healing of these fractures.

Introduction and purpose: According to general experience and our own personal experience, percutaneous surgery using the Isham technique for the correction of hallux valgus has been performed in our country with frequency and good outcomes. However, the results are not easily reproducible, especially in moderate to severe hallux valgus cases. Sesamoid dislocation tends not to change much and the first metatarsal usually remains shortened. Recent publications with results of the Bösch technique are very encouraging. We have started using this technique to determine its effectiveness and the cases when it is most appropriate.

Materials and methods: The study comprised 100 feet operated with Bösch’s technique. In 34 patients we operated both feet simultaneously. In 32 patients one foot had previously been operated using Isham’s technique and subsequently the other foot was operated using Bösch’s technique. Mean age was 68 years (range: 19–82). Patients were female in 91% of cases. Intravenous saline with prophylactic antibiotics was used. Local anesthesia was used on the foot (mepi-bupivacaine). Osteotomy of the first metatarsal was performed according to Bösch’s technique. A bandage, an offload insole and a rigid shoe were used. Patients were administered analgesic and antithrombotic medication.

Results: Skin infection due to the Kirschner wire made it necessary to withdraw the latter during the first 15 days with a loss of 70–80% of the correction. When the Kirschner wire was withdrawn at 4 weeks, in 18 cases there was a loss of correction of 30–60%. One osteotomy currently has the appearance of a painless non-union. The rest of the osteotomies healed satisfactorily at 6–8 weeks. There were no cases of metatarsal head necrosis. In 16 cases there was an undesirable shortening of the metatarsal. Reduction of sesamoid dislocation was achieved in 82% of cases. Joint metatarsalphalangeal movement was normal and painless in 82% of the cases.

Conclusions: Bösch’s technique is very effective for the treatment of moderate to severe hallux valgus. It is necessary to strictly comply with the technique to displace and correctly maintain the metatarsal osteotomy. Bösch’s osteotomy can lengthen, maintain or shorten the metatarsal bone. We currently only use Akin’s distal osteotomy for cases with evident interphalangeal hallux.