Subtle injuries to the Lisfranc joint complex are difficult to diagnose clinically and radiographically and can ultimately result in obvious disability if misdiagnosed. However, no previous study has shown the true mean average distance between the base of the first and second metatarsals (the Lisfranc distance). Therefore, in the present study, the anatomic and radiographic parameters of the Lisfranc joint were studied in detail to assist in the evaluation of Lisfranc injuries. The parameters of the Lisfranc joint complex in 100 normal volunteers and 10 cadavers were measured, including the medial, lateral depth of the mortise joint, width and height of the second metatarsal base, and distance between the base of the first and second metatarsals. The mean average Lisfranc distance was 0.24 ± 0.06 mm in the left foot and 0.25 ± 0.06 mm in the right foot for the radiographic group (p = .089) and 0.39 ± 0.04 mm in the left foot and 0.37 ± 0.04 mm in the right foot for the cadaver group (p = .129). The medial depth and Lisfranc distance in the radiographic group were smaller than the same measurements in the cadaver group, and these differences were statistically significant (medial depth, p < .001; Lisfranc distance, p < .001). The lateral depth and second metatarsal height in the radiographic group were larger than the same measurements in the cadaver group, and these differences were statistically significant (lateral depth, p < .001; second metatarsal height, p < .001). The second metatarsal width was the same in the 2 groups (p = .651). In conclusion, if the Lisfranc distance is >3.0 mm radiographically, a subtle injury to the Lisfranc joint should be highly suspected. No test of stability was performed between shallow and narrow versus deeper and broader Lisfranc mortise configurations. We merely speculated that a deeper and wider mortise is likely to be more stable than one that is shallow and narrow, probably owing to the presence of broader ligaments.

Gauzoma is also called as gauze-induced granuloma, and it always grows rapidly. It is a familiar surgical complication although it is a rare orthopaedic condition. We described a 26-year-old male and he had ever received the operation of open reduction and internal fixation with interlocking nail under the diagnosis of fracture of left femoral shaft about 3 years ago. Removal of implant was performed about two years ago. Unfortunately, a huge mass over medial side of left thigh was found after operation. He received magnetic resonance imaging study and it showed a heterogenous tumor with clear margin. A well-capsuled tumor was resected and multiple-piece gauze retention was noted. It was proved by pathologic report later. Early detection and avoid surgical complication were necessary.

In this report, an original technique for augmentation of chronic biceps femoris tendon avulsion is described. The procedure is developed using a reverse fascia flap of biceps femoris to be a single-tailed graft. Then, a suture anchor is inserted on the fibular head to approximate and fix the retracted the biceps femoris. Finally, a tunnel is drilled at the proximal fibula to let the graft pass through, and the end of the graft loop is sutured to itself. This technique confers effective, firm fixation of chronic biceps femoris tendon avulsion.

Avulsion fracture of the tibial eminence is rare in children. This report describes a case of a 9-year -old boy who had been treated previously with an epiphyseal cannulated screw and washer , but without notchplasty , for an avulsion fracture of the tibial eminence. The patient subsequently presented with extension block and knee stif fness. After removal of the im- plants and manipulation, an iatrogenically-induced distal femur fracture was observed postoperatively with callus forma- tion noted at follow-up. This case serves to illustrate the importance of identifying and treating screw head impingement during f xation surgery, of avoiding vigorous manipulation during removal of f xation devices, and of consulting radio- graphs after any manipulation.