Flexor digitorum brevis tendon transfer to the flexor digitorum longus tendon according to Valtin in posttraumatic flexible claw toe deformity due to extrinsic toe flexor shortening

AbstractClaw toe deformity after posterior leg compartment syndrome is rare but incapacitating. When the mechanism is flexor digitorum longus (FDL) shortening due to ischemic contracture of the muscle after posterior leg syndrome, a good treatment option is the Valtin procedure in which the flexor digitorum brevis (FDB) is transferred to the FDL after FDL tenotomy. The Valtin procedure reduces the deformity by lengthening and reactivating the FDL. Here, we report the outcomes of FDB to FDL transfer according to Valtin in 10 patients with posttraumatic claw toe deformity treated a mean of 34 months after the injury. Toe flexion was restored in all 10 patients, with no claw toe deformity even during dorsiflexion of the ankle

Mid-term survivorship of Mini-keel (TM) versus Standard keel in total knee replacements: Differences in the rate of revision for aseptic loosening

International audienceIntroduction: To reduce the size of the surgical incision, modular mini-keel tibial components have been developed with or without extensions for the Nexgen (TM) MIS Tibial Component. Although a smaller component could theoretically result in defective fixation, this has never been evaluated in a large comparative series. Thus, we performed the following case control study to: (1) evaluate intermediate-term survival of a modular ``mini-keel'' tibial component compared to a reference standard keel component from the same line of products (Nexgen LPS-Flex Tibial Component, Zimmer); (2) to identify any eventual associated factors if the frequency of loosening was increased. Hypothesis: The rate of revision for aseptic tibial loosening is comparable for both components. Materials and methods: This comparative, retrospective, single center series of 459 consecutive total knee arthroplasties (TKA) was performed between 2007 and 2010: with 212 modular ``mini-keel'' (MK) tibial components and 247 ``standard'' (S) components. Survival, rate of revision for aseptic tibial loosening and identification of a radiolucent line were analyzed at the final follow-up. Results: After a median follow-up of 5years, the rate of revision for tibial aseptic loosing was significantly higher in the MK group with 12 cases (5.7%) and 4 cases in the S group (1.6%) (P=0.036). The use of the MK component appears to be a prognostic factor for surgical revision (hazard ratio=3.86 (1.23-11.88), P=0.02) but not for the development of a radiolucent line (HR=1.75 (0.9-3.4), P=0.097). The mean delay before revision was 38months (8-64) in the MK group and 15.2months (8-22) in the S group (P=0.006). Individual factors, such as gender, body mass index (BMI) and pre- or postoperative alignment were not prognostic factors for revision or radiolucent lines. Conclusion: The modular ``mini-keel'' tibial component was associated with a greater risk of revision for tibial component loosening. (C) 2016 Elsevier Masson SAS. All rights reserved

Diaphyseal tibiofibular synostosis in professional athletes: Report of 2 cases

Anterior leg pain is common in professional athletes and tibiofibular synostosis is reported to be a rare cause of anterior compartment pain or ankle pain related to sports activities. The management and appropriate treatment of this condition in professional athletes is controversial and the literature on the topic is sparse. Distal synostosis is usually related to ankle sprain and syndesmotic ligament injury, and proximal synostosis has been linked to leg length discrepancy and exostosis. Mid-shaft synostosis is even less common than proximal and distal forms. We present the treatment of mid-shaft tibiofibular synostosis in 2 cases of professional athletes (soccer and basketball player), along with a review of the literature. When diaphyseal synostosis is diagnosed, first-line conservative treatment, including ultrasound-guided steroid injection is recommended. However, if it does not respond to conservative management, surgical resection may be indicated to relieve symptoms

Synostose tibio-fibulaire diaphysaire chez l'athl\ue8te professionnel: \uc0 propos de deux cas

La synostose tibio-fibulaire a \ue9t\ue9 d\ue9crite comme une cause rare de douleur ant\ue9rieure de jambe ou decheville chez les athl\ue8tes. La prise en charge de ces synostoses est controvers\ue9e et les donn\ue9es de lalitt\ue9rature sont rares. Ces synostoses tibio-fibulaires peuvent \ueatre distales, proximales ou plus rarementdiaphysaires,. Nous pr\ue9sentons la prise en charge de deux synostoses diaphysaires survenues chez deuxathl\ue8tes professionnels (basket et football). Un traitement conservateur comprenant des injections dest\ue9ro\uefdes sous \ue9chographie est recommand\ue9 dans un premier temps. Le traitement chirurgical peut \ueatrepropos\ue9 en cas d\u2019\ue9chec