Background

Morton's neuroma is the enlargement of an interdigital nerve most commonly located between the third and fourth metatarsals. It is susceptible to entrapment and therefore is a common cause of disabling foot pain. Greek foot is a normal variant where the first metatarsal is shorter than the second metatarsal. To our knowledge there is currently no reported association between Greek foot and Morton's neuroma in the literature.

Aims: To assess shoulder function and pain following open reduction and internal fixation of displaced 2, 3 & 4 part fractures of the proximal humerus, using a new fixation plate designed to provide rotation and angle stability.

Methods: Patients treated by open reduction and internal fixation with a PlantTan plate (PTP) in our institution are currently being followed-up for a period of 2 years from time of surgery. Post-operatively Constant-Murley (0–100) and Visual analogue (0–100) scoring systems are being used to assess function and pain at 2, 6, 12, and 24 months post surgery. Complications have been carefully recorded.

Results: Currently 24 patients have been treated with a PTP. Results to 6 months post surgery are presented here. Mean patient age is 65 (31–89), 11 male, 13 female. Three were undertaken for non-union and 21 for acute fractures. At 2 months post surgery mean Constant-Murley Score (CMS) was 24 (12–49) on the fractured side compared to 89 (80–95) on the uninjured shoulder, with a mean Visual Analogue Score (VAS) of 37 (1–82). At 6 months mean CMS was 49 (28–75) for the fractured side compared to 88 (71–100) for the uninjured side, with a mean VAS of 26 (2–69). Three patients have died during the follow-up period; all deaths have been confirmed, by the coroner, as being unrelated to the procedure. Screws have backed out in 3 (12.5%) patients with 1 requiring implant removal and 1 requiring revision. There has been 1 (4.2%) case of frozen shoulder requiring MUA and 3 (12.5%) superficial wound infections. All 3 infections have resolved following a course of oral antibiotics.

Conclusion: We believe the PTP may prove to be a powerful tool in the management of proximal humeral fractures, however further evaluation including long-term follow-up is required. We aim to report on this in the future.

Objective: To provide a functional, anatomical description of the posteromedial structures, allowing future biomechanical studies to evaluate how they act to restrain tibio-femoral joint motion and contribute to joint stability.

Methods: Twenty fresh cadaveric knee joints were dissected. The appearance of the medial ligament complex was recorded using still and video digital photography as the specimens were flexed, extended, internally and externally rotated.

Results: We divided the medial structures into thirds, from anterior to posterior, and into three layers from superficial to deep: Layer 1: Fascia. Layer 2: Superficial MCL. Layer 3: Deep MCL and capsule. In the Posteromedial Corner (posterior third) it is not possible to separate Layers 2 and 3. The posteromedial corner (PMC) envelops the posterior medial femoral condyle. A discrete posterior oblique ligament (POL) is not identifiable. The PMC appears to be a functional unit with a role in passively restraining tibio-femoral valgus and internal rotation with the knee extended. The semimembranosus, through its tendon sheath attachments, may act as a dynamic stabiliser.

Conclusion: The MCL appears to have three functional units:Superficial MCL, Deep MCL and PMC. We believe that this description allows a logical approach to understanding the biomechanics and surgical reconstruction of the posteromedial structures. We plan to use this anatomical study as the basis for further work to evaluate the how these functional units act.