The anatomy of the first metatarso-phalangealjoint and of dorsal dislocation of the phalanx are described. As with similar lesions in the hand, closed reduction is impossible because of interposition of the volar plate. Open reduction is essential and should be performed as soon as possible after the injury

We describe the management of nonunion combined with limb-length discrepancy following vascularised fibular grafting for the reconstruction of long-bone defects in the lower limb after resection of a tumour in skeletally immature patients. We operated on nine patients with a mean age of 13.1 years (10.5 to 14.5) who presented with a mean limb-length discrepancy of 7 cm (4 to 9) and nonunion at one end of a vascularised fibular graft, which had been performed previously, to reconstruct a bone defect after resection of an osteosarcoma. Reconstruction was carried out using a ring fixator secured with correction by half pins of any malalignment, compression of the site of nonunion and lengthening through a metaphyseal parafocal osteotomy without bone grafting. The expected limb-length discrepancy at maturity was calculated using the arithmetic method. Solid union and the intended leg length were achieved in all the patients. Excessive scarring and the distorted anatomy from previous surgery in these patients required other procedures to be performed with minimal exposures and dissection in order to avoid further compromise to the vascularity of the graft or damage to neurovascular structures. The methods which we chose were simple and effective in addressing these complex problems

Aims

Base of thumb osteoarthritis (BTOA) is a common age-related disease which has a significant negative impact upon quality of life. Our aim was to assess current UK practice in secondary care with regard to the nature of non-surgical treatments, the surgical procedures most commonly performed, and factors influencing the surgical decision-making process.

The collagen framework of articular cartilage is disposed, as in other connective tissues, to resist tension forces within the material. In this paper the fine structure of articular cartilage, as demonstrated by polarised light microscopy and electron microscopy, is related to the gross anatomy and to the naked eye changes of chondromalacia and fibrillation

Aims

Intraoperative 3D navigation (ION) allows high accuracy to be achieved in spinal surgery, but poor workflow has prevented its widespread uptake. The technical demands on ION when used in patients with adolescent idiopathic scoliosis (AIS) are higher than for other more established indications. Lean principles have been applied to industry and to health care with good effects. While ensuring optimal accuracy of instrumentation and safety, the implementation of ION and its associated productivity was evaluated in this study for AIS surgery in order to enhance the workflow of this technique. The aim was to optimize the use of ION by the application of lean principles in AIS surgery.

Aims

Carpal malalignment after a distal radial fracture occurs due to loss of volar tilt. Several studies have shown that this has an adverse influence on function. We aimed to investigate the magnitude of dorsal tilt that leads to carpal malalignment, whether reduction of dorsal tilt will correct carpal malalignment, and which measure of carpal malalignment is the most useful.

1. An attempt has been made to correlate the radiographic appearances and the morbid anatomy of the cystic changes that occur in the head of the femur in advanced osteoarthritis. 2. The suggestion is made that these lesions are foci of traumatic bone necrosis. Repair may be complicated by the subsequent entrance of synovial fluid through defects in the surface

Four cases are shown to illustrate remodelling of the lower end of the humerus after supracondylar fractures with displacement in childhood. Remodelling is rapid and will restore almost normal anatomy and good function even with severely displaced fractures. The results are much better than in many cases treated by open reduction

1. A case of total dislocation of the cuboid bone without fracture is described. This is an uncommon injury and to our knowledge has not previously been reported. 2. Its rarity is explained in the light of the structural anatomy and function of the foot. 3. A mechanism of injury is postulated and a method of reduction and fixation described

1. The movements of the talus are described with particular reference to the anatomy of congenital talipes equinovarus. 2. It is suggested that the fundamental deformity in severe club foot is the fixed plantar-flexion of the talus. 3. Early operation is advised whenever serial stretching fails to bring the heel quickly into its normal position

We investigated the relationship of the inferior gluteal nerve to gluteus maximus by dissecting the muscle in 12 fresh-frozen and formalin-treated cadavers. The anatomy was recorded using still digital photography. The course of the inferior gluteal nerve was carefully traced and was noted to enter the deep surface of gluteus maximus approximately 5 cm from the tip of the greater trochanter of the femur. The susceptibility of the nerve to injury during a posterior approach to the hip may be explained by its close relationship to the deep surface of gluteus maximus. It is easily damaged before it has been seen if the muscle is split and parted more than 5 cm from the tip of the greater trochanter of the femur. We suggest that a modified posterior approach be used to expose the hip to avoid damage to this nerve

The microvascular anatomy of the calcaneal tendon was investigated in cadaver tendons by injection of barium sulphate and indian ink and a quantitative study of intratendinous blood supply was made, using a computer-assisted image analysis system. There was a reduction in both the number and the mean relative area of vessels in the mid-section of the tendon. This area of reduced vascularity may be of significance in the pathogenesis of rupture

1. Chondromalacia of the patella starts most frequently on the medial facet. 2. The anatomy of the medial femoral condyle is described, including the rim at its superior border, and the different arrangement at the upper border of the lateral femoral condyle. 3. Rubbing of the medial patellar facet on the rim at the upper border of the medial femoral condyle can explain in part the etiology of chondromalacia

1. A case of traumatic aneurysm in the popliteal fossa after a lateral meniscectomy is described. 2. Relevant factors in the surgical anatomy of the inferior genicular artery are discussed. 3. The value and limitations of angiography of the popliteal artery are considered. 4. Treatment is governed by the degree of involvement of the popliteal artery. In the case described cure of the aneurysm was obtained by endo-aneurysmorrhaphy

Aims

While previously underappreciated, factors related to the spine contribute substantially to the risk of dislocation following total hip arthroplasty (THA). These factors must be taken into consideration during preoperative planning for revision THA due to recurrent instability. We developed a protocol to assess the functional position of the spine, the significance of these findings, and how to address different pathologies at the time of revision THA.

We performed MRI on 13 infants after operative reduction for developmental dysplasia of the hip (DDH). Using an axial gradient-echo sequence, MRI accurately depicted the acetabular anatomy and confirmed adequate reduction in 12 patients. The one patient with redislocation after surgery was correctly identified. MRI can be carried out quickly, inexpensively and without risk of radiation and is the investigation of choice to confirm adequate reduction in DDH

Exposure of the prosthesis is one of the problems encountered after arthroplasty of the knee. Eight patients with nine exposed prostheses have been treated by using a gastrocnemius myocutaneous flap to provide cover. This preserved the prosthesis and closed the joint in six of the eight patients.l The factors leading to breakdown of the wound are discussed and the anatomy of the gastrocnemius myocutaneous flap and the operative procedure are described

1. Dislocation or sublaxation of the inferior radio-ulnar joint in association with fractures of the head of radius is discussed. 2. The incidence of the complication is greater than is generally supposed, and figures are given to support this finding. 3. The subluxation is not always associated with symptoms, and the degree of displacement may not be sufficient to be recognised clinically. 4. The anatomy and mechanism of the displacement have been investigated experimentally, and the results of the experiments are described