Aims

The aim of this study was to report a single surgeon series of consecutive patients with moderate hallux valgus managed with a percutaneous extra-articular reverse-L chevron (PERC) osteotomy.

Purpose: Endoscopy provides an attractive alternative to open surgery for diagnostic and therapeutic purposes in patients with ankle tendon disease. Early work was published by Van Dijk in 1994.

Material and methods: Twenty patients (mean age 34.7 years, range 20–59 years), 16 with posttraumatic lesions, underwent 22 tendinoscopy procedures using a slightly modified technique with a 4.5 optical. The procedures, conducted under general anaesthesia, were performed to explore fibular (n=15), posterior tibial (n=6), and anterior tibial (n=1) tendons. Prospective follow-up was at least six months (6 – 30). Preoperatively, all patients presented more or less localised pain with signs of tendon suffering. Fifteen had undergone prior explorations (ultrasound=4, MRI=7, CT scan=1, MRI+ultrasound=3) which had not revealed any anomaly in seven.

Results: Peritendinous adherences were observed intra-operatively in 18 cases with inflammatory reactions requiring resection in 13. A lesion of the tendon itself was found in seven cases-fissure (n=2), superficial dilaceration (n=2), induration (n=2), strangulation (n=1)-which required specific cure with forceps or motorised instrumentation. No explanation of the pain could be identified in one patient. Postoperatively, 17 patient achieved complete pain relief which persisted for at least six months. At last follow-up, one patient had not been reviewed, twelve were totally pain free and five had developed associated symptoms (cracking, swelling). Overall, four patients were very satisfied, eight were satisfied, four were disappointed, and three were dissatisfied (no improvement). There were no signs of worsening and no complications directly related to the method.

Conclusion: These results of early experience in France are less satisfactory than those reported by Van Dijk who had 80% good results for 85 tendinoscopic procedures in 70 patients. They do however confirm the usefulness of this technique for the management of patients with tenosynovitis, adherences, and partial ruptures of the ankle tendons which cannot always be identified with classical imaging techniques. Definitive evaluation will require analysis of a larger series of well selected patients.

Purpose: We report a retrospective analysis of 20 patients with complex fracture of the distal radius treated in an emergency setting with an external fixation and complementary osteosynthesis.

Material and methods: These 20 patients, mean age 43 years, fifteen men and five women were treated between January 1998 and November 2000. The dominant limb was involved in 16 cases. There were ten manual labourers and four patients who had regular sports activities. The surgical procedure included manual reduction then application of an external fixator (Orthofix). The second time was for insertion of an anterior plate in nine cases. For seven patients, pinning was associated with the plate. Only eleven patients were treated with external fixation and pinning alone. Mean hospitalisation was ten days. Active rehabilitation of the fingers included daily exercises. All external fixators had been removed on day 45.

Results: Mean follow-up was 22 months. Clinically, mean outcome was: palmar flexion 40°, dorsal flexion 36°, radial inclination 12°, ulnar inclination 15°, pronation 75°, supination 62°. Force was often less than 20% of the contra-lateral side. Radiologically, mean results were: on the AP view radial tilt 23°, radioulnar distance +1 mm, mean radial; and on the lateral view, radial tilt −1.4°. Bone healing was achieved on day 45. Two patients developed severe reflex dystrophy. There were no infectious or skin complications. Two patients developed a carpal tunnel syndrome. The plate was removed in two cases. Two patients developed palmar dysaethesia. Two patients had a complementary procedure on the distal radioulnar joint due to defective supination. Eleven patients resumed their occupational activities at a mean six months.

Discussion: The purpose of this analysis was to determine, retrospectively, the role of external fixation of the wrist associated with complementary osteosynthesis in patients with complex fractures of the distal radius. These extra- and intra-articular fractures are difficult to treat and require minute analysis. Outcome in our patients indicated that this analysis is often incomplete before treatment. We had four patients with a stair-step joint surface due to defective primary reduction. The radius was usually well reduced in the frontal plane but the sagittal plane was rarely corrected. The radioulnar distance evolved unfavourably in eight patients reaching > +2mm. Our poorest results were in cases with external fixation and pinning. The best results were obtained with combined treatment using a plate, pins and the external fixator.

Conclusion: We advocate a very careful and rigorous analysis of the fracture, in agreement with the SOFCOT 2000 symposium concerning complex fractures, and prefer a triple surgical procedure using a plate, pins and the external fixator.

We report ten cases of rupture of the distal part of the tendon of biceps brachii in patients aged from 27 to 58 years. MRI allowed assessment of the degree of retraction of the tendon which was related to the integrity of the bicipital expansion. When the retraction exceeded 8 cm the expansion was always ruptured. When there was doubt, or in longstanding injury, MRI allowed the lesions to be defined.

Surgical repair was by reinsertion on the radial tuberosity at one or two fixation points in eight patients and reinsertion on the anterior brachial muscle in one. The other patient refused surgery. The MRI findings were confirmed at operation. Use of fixation points allowed minimal intervention, thereby reducing the risk of damaging the radial nerve. One year after operation, dynamometric evaluation of the strength of flexion and supination confirmed that the best results were obtained by reinsertion to the radial tuberosity.

We report two cases of epicondylitis of the elbow occurring after treatment with fluoroquinolone antibiotics. Both patients had intense pain which appeared very shortly after the first dose of the drug and was not relieved by conservative treatment. Ultrasonography revealed extensive inflammatory lesions with pseudonecrotic areas. MRI confirmed the lesions and also showed a subclinical abnormality of the adjoining tendons. The persistent nature of the pain was the indication for surgical release of the extensor mechanism. After operation pain disappeared completely and the patients were able to return to their normal activities. Lesions of the tendo Achillis are a well-known side-effect of treatment with fluoroquinolone. Our two cases show that such lesions may occur elsewhere. They also indicate the need for caution when prescribing these antibiotics to patients at risk of tendon lesions, such as top-level sportsmen or patients on dialysis or steroid treatment.