A 15-year-old girl presented with a four-year history of pain in the left ankle. There was no known trauma, only a postnatal soft tissue infection which had healed with no sequelae. Radiographs showed that the talus consisted of two large fragments and one small one

We have reviewed seven cases of synovitis caused by date palm thorns, six involving the knee and one the ankle. Five were satisfactorily treated by thorough irrigation of the joint with normal saline, but two required arthrotomy and synovectomy. All made a full recovery

1. A patient with complete ischaemia of the muscles of the calf and anterior compartment of the leg is described. 2. In diagnosis, tenseness of the calf, equinus and pain on attempted dorsiflexion of the ankle are most important. 3. Peripheral pulses may be present and do not contra-indicate decompression by operation to prevent ischaemia

A case of traumatic aneurysm of the peroneal artery at the level of its perforating branch is described. The intimate and variable relationship of this vessel to the flexor hallucis longus muscle and the tethering effect of its perforating branch predispose to its damage in operations through the postero-lateral approach to the region of the ankle

Osteochondral fractures of the talus are uncommon. They are classified according to Berndt and Harty, as progressing in severity through four stages. This classification, however, does not address extra-articular extrusion of the osteochondral fragment. We report an osteochondral lesion of the talar dome which presented as an extruded extra-articular fragment in a closed injury of the ankle. This type of lesion may offer a continuation to the four original stages. Clinicians should be aware that this pattern of fracture can occur, and thus allow a more accurate diagnosis and the provision of some aid in the treatment of these injuries

We describe the reconstruction of a defect of the medial malleolus which was the result of an accident in a ten-year-old child. A graft from the iliac crest, with the apophyseal cartilage and perichondrium, was used for reconstruction of the medial malleolus, the growth plate and the adjacent metaphyseal defect, respectively. The soft-tissue defect was covered with a free scapular flap with microvascular anastomosis. Three years after the injury stability of the ankle is excellent with adequate growth of the reconstructed epiphyseal plate

One hundred patients who had sustained a fracture of the tibial shaft and had been treated by internal fixation were reviewed to obtain information on residual ankle and subtalar disability. This study reinforces the belief that early mobilisation of patients with tibial shaft fractures does help to preserve subtalar movement

With the aim of controlling pain after Keller's operation, a solution of a long-acting local anaesthetic was instilled into the field before closure in a series of thirty patients. In a controlled prospective trial this simple technique by itself proved to be significantly better than either foot block at the ankle or the usual analgesics and was free from local or systemic complications

The interosseous route remains popular for tibialis posterior tendon transfer for drop-foot. It leaves a smaller range of movement than the circumtibial route, but lengthening the calcaneal tendon may improve this. The results of this present series indicate that, in order to predict a good functional result, the ankle must be held in at least 20 degrees of dorsiflexion at the time of tendon transfer

The clinical details of six patients who developed spontaneous dislocations in the foot or ankle are presented. All were shown to have diabetic neuropathy. This previously unreported condition can occur with a short history of diabetes. Some cases can be managed without operation, though arthrodesis probably offers the best chance of obtaining a stable foot of satisfactory shape

A prospective study of 33 civilian parachutists with 41 injuries is presented. Because the training for civilians is less rigorous than that for military parachutists, the hospital admission rate for severe injuries was high (81.8%). Most injuries occurred during landing and the ankle was most frequently involved. The types and possible mechanisms of injury are discussed, as well as recommendations for modifying the civilian training programme

Sixteen severely haemophilic patients have undergone arthrodesis of one joint of the lower limb in the period 1966 to 1976. There have been nine arthrodeses of the knee and seven of the ankle. The follow-up period was from nine months to eight years. The arthrodeses were secured by internal fixation. The method was not without complications, but a satisfactory bony union resulted in all cases without further surgical intervention

We compared two conservative methods of treating Weber B1 (Lauge-Hansen supination-eversion 2) isolated fractures of the lateral malleolus in 65 patients. Treatment by immediate weight-bearing and mobilisation resulted in earlier rehabilitation than immobilisation for four weeks in a plaster cast. There was no significant difference in the amount of pain experienced or in the requirement for analgesics and early mobilisation was not associated with any complications. We therefore advocate early mobilisation for these stable ankle fractures

The results of 10 patients with severe rigid drop-foot corrected by the Lambrinudi triple arthrodesis were studied. The average amount of correction was 47 degrees, as evaluated from standing radiographs taken before and after operation. Radiological features of osteoarthritis and of flattening of the talus were common, but the feet were painless when reviewed at an average of 70 months later. A satisfactory range of movement was obtained at the ankle joint

We report a new method of ankle arthrodesis which combines an anterior approach with a dowel technique of bone grafting and screw fixation. In 20 ankles of 20 patients, ten with osteoarthritis, eight with rheumatoid arthritis and two others, we achieved 19 solid bony fusions and one painless fibrous ankylosis. The average time to union was 12.5 weeks. Patient satisfaction was high and the functional results were as good as for other reported methods, with fewer complications

1. The cases of four children who presented with bowing or pseudarthrosis of the fibula only, are described. 2. There is a gradation in the severity and significance of this condition. There may be fibular bowing without fibular pseudarthrosis; fibular pseudarthrosis without ankle deformity; fibular pseudarthrosis with deformity but without the late development of tibial pseudarthrosis; or fibular pseudarthrosis with the late development of tibial pseudarthrosis. 3. Proper management is dependent on a knowledge of this range of conditions

1. Previous papers on the subject of the os trigonum are reviewed. 2. Evidence is produced to show that the posterior part of the talus normally develops from separate centres. 3. An explanation is given for the presence in adults of separate ossicles (the so-called os trigonum) in one or both ankles and for the variety of shapes adopted by them. 4. Contrary to opinions expressed by previous writers, these ossicles may give rise to symptoms

A method is described which provides standardised reproducible radiographic images of the lower limb. Anteroposterior and lateral radiographs are digitised and processed by computer to provide graphic/numeric displays of angles and linear measurements, relating the centre points of the hip, knee, and ankle. Two cases illustrate how surgical planning is facilitated when standardised data are available. These data confirm the close relationship between postoperative limb alignment and positioning of prosthetic elements

An anteroposterior radiograph of the leg to include the hip and ankle, taken with the patient standing, provides an estimate of the line of load-bearing at the knee. Gait analysis may be used to determine the way in which the load in the knee is shared between the medial and lateral compartments during normal walking. A comparison of the results from the two methods, carried out on a group of 47 patients, led to the conclusion that both calculations are required for the successful outcome of a tibial osteotomy or a total arthroplasty