The purpose of this study is to present the surgical and functional results of a partial and total calcanectomy procedure as a foot salvage alternative in patients with extensive chronic osteomyelitis of the calcaneus.

Material: A retrospective review identified 19 calcanectomies in 16 patients: 5 partial, 11 total and 3 partial to total. The primary diagnosis was insulin-dependent diabetes mellitus (3 patients), neurophatic ulceration (2 patients), infected osteosynthesis (4 patients) and open fracture (7 patients). The average age of the patients was 42.36 years (range from 22 to 60). Prior procedures included removal of osteosynthesis, debridement, Gaenslen’s procedure and skin grafting. Operation was based in Martini’s technique. Most common bacteria were Staphylococcus aureus. Antibiotic treatment was based in cultures and has changed during this period of time.

Results: Four patients were lost (2 died) and the rest average follow-up was 9.8 years (range from 1 to 19 years). Recurrence of infection was present in 3/5 partial calcanectomies and in 1/14 of total calcanectomies. Talonavicular subluxation occurred as a late complication in the patient with recurrence after total calcanectomy and underwent a below-knee amputation. An assessment of functional ambulation was performed in all 16 patients according Volpicelli scale; the lost patients were recorded last time they were visited. All ambulatory patients needed a modified heel-containment orthosis.

Conclusions: Total calcanectomy is an alternative procedure to a bellow-knee amputation in patients with chronic osteomyelitis of the calcaneus. In our hands, partial calcanectomy has worse results in eradication of infection and we have left it.

Some different biodegradable vehicles have been tried in vitro and in vivo as possible methods of local antibiotic therapy.

The aim of this study is to evaluate the effectiveness of collagen-gentamicine (Collatamp^®) to eradicate bacterial colonisation of different biomaterials used in orthopaedic surgery in an in vitro study.

Three samples of similar shapes and dimensions of 4 different materials: stainless steel screw, titanium screw, titanium canulated screw and a cylinder of polyethylene were used. Three different solutions of 49 cc of thioglicolate plus 1cc of solution of methicillin-susceptible and methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis (MacFarland: 3) were prepared. Each solution received one sample of each material so that every material be tested in all 3 preparations. After incubation during one week and confirmation of bacterial colonisation of each sample by swabbing cultures, all of them were introduced in an individual receptacle containing 50 cc of thioglicolate and a piece of 5x5 cm of collagen-gentamicine (corresponding to 650 mg/ml of gentamicine). After incubation we analysed results by new swabbing cultures of all samples.

All samples were highly contaminated with different bacteria before introducing them in thioglicolate with the piece of collagen-gentamicine. After one week all samples were free of bacteria.

This in vitro study demonstrates the effectiveness of collagen-gentamicine in order to eliminate colonisation of different biomaterials used in orthopaedic surgery by most frequent bacteria.

Introduction and purpose: Numerous surgical procedures have been developed for the treatment of chronic ankle instability, which can be broken down into two: tenodesis of the peroneus brevis and ligament capsuloplasty. We assess the indications for these procedures, discuss their advantages and disadvantages based on a comparative review, and describe an algorithm in the treatment of this pathology.

Materials and methods: We reviewed 21 patients who underwent surgery from 1997 to 2001. In 10 of the patients the operation consisted of a Castaing II procedure with tenodesis of the peroneus brevis, and in 11 a Larsson procedure was performed as a ligament capsuloplasty. The ankle was evaluated using the AOFAS scale.

Results: The age difference between the two groups, which was 40 for those undergoing the Castaing II procedure and 28 for the Larsson technique. The mean AOFAS score was 80% (min. 70%, max. 95%) for the Castaing II procedure and 86% (min. 71%, max. 97%) for the Larsson technique.

Conclusions: The use of tenodesis with the peroneus brevis is indicated for severe ankle instability, failed anatomical repairs and in patients with connective tissue pathology. A capsuloplasty that attempts to reconstruct the lateral ligaments of the ankle as anatomically as possible is indicated for mild-to-moderate chronic instability in young patients.

Objective: The objective of this study is to evaluate the role of quadriceps tightness in patients with patellar symptoms.

Material and methods: We evaluated 64 patients (12 men and 52 women) diagnosed of patellar malalignment, chondromalacia, patellar pain, patellar subluxation... in 100 knees. We defined 2 groups according the presence or not of imaging disorders: Group A (48 knees) with normal x-ray and CT-scan; group B (52 knees) with malalignment in x-ray or CT-scan. In both groups we evaluated quadriceps tightness by placing the patient prone and passively bringing the heels toward buttock. Average distance between heels/buttock (HBD) was 9.1 cm. in both groups before treatment and none presented HBD = 0 cm. Treatment consisted in passive quadriceps stretches after warm-up.

Results: After 11 rehabilitation sessions (range: 9–12), average HBD was 2.5 cm. in group A and 3.6 cm. in group B. HBD = 0 cm. was present in 32/48 knees in group A and 12/52 knees in group B. With a follow-up of 36–48 months, patients with HBD = 0 and values of HBD similar to values after treatment were present in both groups. After follow-up, pain was reported in 4/36 patients in group A and 20/28 in group B.

Conclusions: Quadriceps tightness is always present in patients with patellar symptoms and it is a valuable and reproducible sign. Passive quadriceps stretches are highly effective in patients with normal imaging tests and can be useful before surgery in patients with patellar malalignment

Objective: The objective of this retrospective study is to evaluate our results with proximal closing-wedge osteotomy of first metatarsal for the treatment of hallux valgus with severe intermetatarsal (IM) angle and normal proximal articular set angle (PASA).

Material and methods: We reviewed 110 patients (141 feet) who had been treated by proximal closing-wedge osteotomy of first metatarsal between March-97 and February-04. 87% were women and the mean age was 47.8 years. A single cannulated screw was used for osteotomy fixation in 82% of patients. Additional procedures as phalangeal osteotomy or Keller resection were done when necessary.

Results: With a mean follow-up of 42.3 months, correction of the deformity was good or excellent in 80.5% of cases and fair in 15.4%. Pain due to bunion disappeared in 94.3% of feet. Mean preop IM (angle) was 17.3 and postop was 7.9. Metatarsal-phalangeal angle improved from 42.4 to 15.9. Fusion was achieved in 6.8 weeks (average). Complications were: hypercorrection in 13 feet (2 required reoperation); recurrence of deformity in 10 feet (1 reoperation); central metatarsalgia in 8 feet. Neither infection nor nonunions were observed. Patient satisfaction was excellent or good in 92.7% of patients.

Conclusion: Proximal closing-wedge osteotomy of first metatarsal is a good technique for the treatment of hallux valgus with severe IM angle and normal PASA. It is an easy and reproducible technique with good results, low number of complications and a high rate of patient satisfaction