Les ostéotomies diaphysaires du 5eme métatarsien ont prouvé leur efficacité dans le traitement de la bunionette. Nous adaptons l’ostéotomie scarf sans vis du premier métatarsien au cinquième rayon. Cette note décrit la technique, par ostéotomie courte, translation et ostéo-suture diaphysaire. Nous rapportons les 25 premiers pieds opérés avec un score AOFAS préopératoire moyen de 58,4 et de 94,9 en postopératoire, à 25 mois de suivi moyen. Les résultats sont comparables aux données publiées, quelle que soit la déformation.

Fifth metatarsal shaft osteotomy has demonstrated efficacy for bunionette. We adapted screwless 1st metatarsal scarf osteotomy to the 5th ray. The technique consists in short osteotomy, translation and diaphyseal bone-suture. We report the first 25 operated feet, with mean AOFAS score 58.4 preoperatively and 94.9 postoperatively at a mean 25 months' follow-up. These results were comparable to reported data, whatever the deformity.

Long second-toe syndrome, although frequent and disabling, has been little described. Current surgical techniques often lead to loss of function. Based on anatomical and biomechanical observations, the present study reports a second phalanx shortening osteotomy technique. The procedure is relatively non-invasive, involving self-stabilizing segment resection osteotomy of the second phalanx. Results for the first 23 feet undergoing the procedure were analyzed retrospectively. Assessment comprised clinical examination, radiography and AOFAS and FAAM scores. Mean follow-up was 19±9.9 months. Second phalanx shortening osteotomy proved reliable, respecting the biomechanics of the toe.

Le syndrome du deuxième orteil long est une pathologie peu décrite mais fréquente et invalidante. Les techniques chirurgicales actuelles conduisent souvent à une perte de fonction de l’orteil. Partant d’observations anatomiques et biomécaniques, nous suggérons une ostéotomie accourcissante de la deuxième phalange. Il s’agit d’un geste peu invasif, impliquant une ostéotomie auto-stable de résection segmentaire de la deuxième phalange. Nous avons étudié rétrospectivement les résultats des 23 premiers pieds opérés. Les résultats ont été évalués par un examen clinique, une radiographie et les échelles AOFAS et FAAM. Le suivi moyen était de 19 ± 9,9 mois L’ostéotomie accourcissante de la deuxième phalange apparaît être une procédure fiable, respectueuse de la biomécanique de l’orteil.

Background: Isolated subtalar arthrodesis is the treatment of choice for several conditions-mostly subtalar arthritis, tarsal coalition and posterior tibial tendon dysfunction-unresponsive to conservative treatment. Arthroscopic procedures are an interesting recent alternative, less invasive than conventional open techniques. Posterior arthroscopy, in prone position, could be more advantageous than the conventional lateral and/or anterior approach.Patients and methods: Ten cases, from 20 to 59-years-old, were prospectively followed up for minimum of one-year (range 12 to 31 months). Arthritis and tarsal coalition were the most common indications.Results: Fusion was observed in all cases at a maximum of nine weeks. Mean average AOFAS score improved from 47 to 78. No complications were noted related to the technique. Only two patients, operated for a symptomatic subtalar coalition, complained of some residual pain due to a lateral submalleolar impingement. Interest of preservation of vascular talar supply and bone grafting are discussed.Conclusion: The good results using this innovative technique are encouraging. Long-term randomized studies remain necessary to confirm the reliability of the procedure in these different indications, and the type of bone graft to favour, if really needed.Level of evidence: Level IV therapeutic study. (C) 2011 Elsevier Masson SAS. All rights reserved.

Isolated subtalar arthrodesis is the treatment of choice for several conditions – mostly subtalar arthritis, tarsal coalition and posterior tibial tendon dysfunction – unresponsive to conservative treatment. Arthroscopic procedures are an interesting recent alternative, less invasive than conventional open techniques. Posterior arthroscopy, in prone position, could be more advantageous than the conventional lateral and/or anterior approach. Ten cases, from 20 to 59 years old, were prospectively followed up for minimum of one year (range 12 to 31 months). Arthritis and tarsal coalition were the most common indications. Fusion was observed in all cases at a maximum of 9 weeks. Mean average AOFAS score improved from 47 to 78. No complications were noted related to the technique. Only two patients, operated for a symptomatic subtalar coalition, complained of some residual pain due to a lateral submalleolar impingement. Interest of preservation of vascular talar supply and bone grafting are discussed. The good results using this innovative technique are encouraging. Long term randomised studies remain necessary to confirm the reliability of the procedure in these different indications, and the type of bone graft to favor, if really needed. Level IV Therapeutic study.

The development of periprosthetic malignancy in proximity to an arthroplasty has been a matter of debate since it was first reported in 1978. We report a case of tibial angiosarcoma, an extremely rare malignancy, which developed in proximity to a primary knee arthroplasty performed ten years before. To our knowledge this is the second case ever described around a knee arthroplasty. While implantation of orthopaedic material can induce the development of malignant tumours in experimental animals, the overall incidence of malignancy recorded following arthroplasty in clinical studies does not appear to be increased compared to the control population. Each case of periprosthetic malignancy following arthroplasty must receive attention in order to better understand the underlying pathology and to measure the possibility for an increased risk of development of specific cancer types.

Autograft is considered as the gold standard in bone grafting. However, the development of tissue banks has allowed for a wider use of bone allografts, with good results. Demineralised Bone Matrix (DBM) and recombinant human Bone Morphogenetic Proteins (rh-BMP's) were also introduced to replace the time-honoured autograft. Is there currently still a place for bone autograft? The authors reviewed the orthopaedic surgical activity in their institution during the period 2003-2005, and traced all the surgical procedures in which bone grafting was performed. Tracking forms from the tissue bank were reviewed to assess the surgical indications. Between 2003 and 2005, the use of autografts decreased from 1.3% to 0.9% of all surgical interventions, particularly owing to their decreased use in primary fusions, while the use of allografts increased from 10.7% to 12.7%. Indications for allografts covered all fields of orthopaedic surgery, including nonunions. Processed allografts represented 90% of all grafts used. DBM and rh-BMP were used on an exceptional basis. There is currently a trend for surgeons to use allografts as substitutes for autografts, as processing of the allografts increases their safety while preserving most of their biological and mechanical properties. Autografting is now limited to revision operations after failed fusions, and to combined use at the junction with massive allografts. DBM and rh-BMP are still controversial but they might replace autografts, even in their currently remaining indications, if their cost effectiveness and efficiency are established.

The authors reviewed available publications concerning the dorsal bunion, a vertical deformity of the first ray of the foot. After describing the clinical side and the usual patient complaints, they analyse the lesion's mechanisms, based on the muscular imbalance of the foot and its joints and describe the causes to the dorsal bunion, especially clubfoot and its surgical correction. The numerous surgical treatments of the dorsal bunion are detailed by order of publication. Then the authors report a recent case of dorsal bunion with illustrations before and after surgery.