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.

Injury to the sciatic nerve following closed manipulation of a dislocated total hip replacement is rare. We present such a case in an elderly patient with partial recovery following exploration and release of the nerve.

In this cross-over study, we evaluated two types of knee brace commonly used in the conservative treatment of osteoarthritis of the medial compartment. Twelve patients confirmed radiologically as having unilateral osteoarthritis of the medial compartment (Larsen grade 2 to grade 4) were studied. Treatment with a simple hinged brace was compared with that using a valgus corrective brace. Knee kinematics, ground reaction forces, pain and function were assessed during walking and the Hospital for Special Surgery scores were also determined.

Significant improvements in pain, function, and loading and propulsive forces were seen with the valgus brace. Treatment with a simple brace showed only significant improvements in loading forces. Our findings suggest that although both braces improved confidence and function during gait, the valgus brace showed greater benefit.

We have reviewed the literature on the anatomy of the posteromedial peripheral ligamentous structures of the knee and found differing descriptions. Our aim was to clarify the differing descriptions with a simplified interpretation of the anatomy and its contribution to the stability of the knee.

We dissected 20 fresh-frozen cadaver knees and the anatomy was recorded using video and still digital photography. The anatomy was described by dividing the medial collateral ligament (MCL) complex into thirds, from anterior to posterior and into superficial and deep layers. The main passive restraining structures of the posteromedial aspect of the knee were found to be superficial MCL (parallel, longitudinal fibres), the deep MCL and the posteromedial capsule (PMC). In the posterior third, the superficial and deep layers blend. Although there are oblique fibres (capsular condensations) running posterodistally from femur to tibia, no discrete ligament was seen. In extension, the PMC appears to be an important functional unit in restraining tibial internal rotation and valgus.

Our aim was to clarify and possibly simplify the anatomy of the posteromedial structures. The information would serve as the basis for future biomechanical studies to investigate the contribution of the posteromedial structures to joint stability.

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.

The use of a valgus brace can effectively relieve the symptoms of unicompartmental osteoarthritis of the knee. This study provides an objective measurement of function by analysis of gait symmetry. This was measured in 30 patients on four separate occasions: immediately before and after initial fitting and then again at three months with the brace on and off. All patients reported immediate symptomatic improvement with less pain on walking. After fitting the brace, symmetry indices of stance and the swing phase of gait showed a consistent and immediate improvement at 0 and 3 months, respectively, of 3.92% (p = 0.030) and 3.40% (p = 0.025) in the stance phase and 11.78% (p = 0.020) and 9.58% (p = 0.005) in the swing phase. This was confirmed by a significant improvement at three months in the mean Hospital for Special Surgery (HSS) knee score from 69.9 to 82.0 (p < 0.001). Thus, wearing a valgus brace gives a significant and immediate improvement in the function of patients with unicompartmental osteoarthritis of the knee, as measured by analysis of gait symmetry.