Chevron osteotomy for the treatment of hallux valgus.

Seventy-six chevron osteotomies with follow-up periods ranging from six months to eight years were reviewed. The majority of patients had pain over the bunion prior to operation, and 27 also presented with second metatarsalgia. After surgery there was a marked decrease of pain in the first metatarsophalangeal joint, and in 18 feet the second metatarsalgia was either eliminated or markedly decreased. Most patients were pleased with the appearance of the feet after surgery, but almost one-third of the women complained of difficulty in wearing high heels. The surgical technique is straightforward, but careful attention to detail is necessary to obtain a consistent and satisfactory result.

Studies of dynamic ligamentous instability of the knee by electrogoniometric means.

Ligamentous injuries to a knee joint increase the risk of post-traumatic degenerative changes. Successful early diagnosis and treatment of such injuries remains a challenging and controversial task. There are a variety of clinical tests available and some of these are difficult to perform and interpret. These clinical tests are really static in nature and may not reveal the presence of what is essentially a dynamic event. A complete assessment would need to be "dynamic" and by its application during ambulation, incorporate the effects of ground-foot forces, joint motions and muscle activities. At the Ontario Crippled Children's Centre (OCCC) a triaxial electrogoniometer system (extensively modified CARS-UBC) has been used, together with complementary gait laboratory instrumentation, in order to study the knees of 16 male subjects. Ten subjects had knees without evidence of injury and six had a variety of cruciate and menisceal tears. The purpose of the study was to investigate if a subject's knee could be classified as "normal" or "unstable" by using just the data provided by the electrogoniometer during walking trials. These data are difficult to interpret in their time series form because they are multidimensional and in all subjects likely to exhibit subtle stride to stride variations. The method described allows the mapping of this data into an abstract two dimensional co-ordinate system, resulting in a set of trajectories which cluster together for data belonging to the "normal" group. Only two subjects, with grossly unstable knees, were judged different from normal using a level walking test protocol. Some potential reasons for this are discussed.

The assessment of skin viability using fluorescein angiography prior to amputation.

Fluorescein angiography was used for the preoperative assessment of skin viability and the determination of the level of amputation in patients with peripheral vascular disease. In twenty-two patients requiring twenty-seven lower-extremity amputations (including five revisions), a retrospective comparison was made between the surgeon's choice of amputation level based on clinical criteria and that based on the fluorescein angiogram. As was evident by the failure of the amputation to heal, the surgeon's prediction was too distal in nine (33 per cent) of twenty-seven amputations and revisions. The assessor of fluorescein angiograms predicted five of these nine failures; therefore, the failure rate could have been reduced to four (15 per cent) of twenty-seven amputations. The amputation level predicted on the basis of the fluorescein angiogram was unnecessarily high in three lower limbs (11 per cent). These three amputations healed at the level chosen by the surgeon, but did so by prolonged secondary healing. Fluorescein angiography is a simple, safe, and useful preoperative bedside technique for the assessment of skin viability and the determination of amputation level in patients with peripheral vascular disease.

Olecranon fractures: a review of 100 cases.

Olecranon fractures in the adult are a common upper extremity injury. There is still no universally accepted classification of these fractures and no uniformity of treatment. Results stated vary considerably, and support can be found in the literature for any of several forms of operative treatment. A review of the literature on olecranon fractures is presented. A system of classification of these fractures based on lateral roentgenograms is proposed; Type I, IIa, IIb, and III (depending on location in the olecranon). An assessment of the results of treatment of 100 patients with such fractures treated by surgical methods is presented. Open reduction and internal fixation with tension band, screws, plate and screws, or band, plate, and screws can be relied upon for satisfactory end results. Type I fractures can be treated by anatomic reduction and tension band wiring; all Type II fractures by tension band technique; Type III fractures with a plate and screws.

Dorsal radiocarpal fracture dislocation.

A case of a rare radiocarpal fracture dislocation in a 17-year-old girl, with persisting loss of radiocarpal joint space following reduction under hematoma block, is described. The wrist joint was exposed, and two osteochondral fragments were rotated 90 degrees and secured with 2.7-mm AO screws. Satisfactory healing followed 3 months postinjury.