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[Fracture of the base of metatarsus V--conservative or operative treatment?].

A follow-up study is given of 138 fractures of the base of the metatarsale V. In the years 1976-1980 124 of these fractures were treated conservatively, 14 operatively. In 1982 all patients were examined personally to find out the treatment with the best results. According to these results the authors consider the conservative treatment the preferable method.

Adolescent↗

[Correction of acquired metatarsus elevatus and hallux flexus: technique used in nine cases].

Nine cases of acquired metatarus elevatus or horizontalization of the first metatarsal with hallux flexus (dorsal bunion) were treated surgically associating: plantar wedge resection of the base of the first metatarsal or the first cuneiform; distal disinsertion of the long hallux flexor which was then positioned under the base of the first metatarsal and finally fixed on the distal dorsal segment of the metatarsophalangeal capsule; distal disinsertion of the anterior tibial tendon and tenodesis of the posterior tibial tendon. Weight bearing was allowed after pinning for one Month to position the axis of the first ray. Morphological results, recorded at 11 Years follow-up (mean) were satisfactory. There were no recurrent deformations and no residual instability of the first ray. The only observation was a minimal stiffness of the metatarsophalangeal joint with no tendency to degeneration.

Adult↗

An investigation of injection techniques for local analgesia of the equine distal tarsus and proximal metatarsus.

A positive radiographic contrast agent was injected into the tarsometatarsal (TMT) joints of both hindlimbs of 10 horses. Lateromedial radiographic views were obtained at 5, 15 and 30 mins after injection. Injection was successful in 19 of 20 limbs. Communication between the centrodistal (CD) and TMT joints was identified in 7 limbs (35%). Contrast agent extended around the tendons of tibialis cranialis (TC) and fibularis tertius (FT) in 18 limbs, and in 7 limbs some contrast entered the tarsal sheath. Slight to moderate plantar and/or distal extension of contrast agent was identified in 13 limbs. On a subsequent occasion positive contrast agent was injected subtarsally using one of two techniques and radiography was repeated. Contrast agent was principally distributed on the plantar aspect of the 3rd metatarsal bone, the plantar aspect of the suspensory ligament and between the superficial and deep digital flexor tendons. Extension of contrast agent into the TMT joint was identified in only 1 limb but in 8 limbs contrast agent extended into the tarsal sheath. The practical implications of these results include the possibility that local anaesthetic solution injected into the TMT joint may alleviate pain from the CD joint, the insertions of TC and FT or the tarsal sheath. It may also result in perineural analgesia of the dorsal metatarsal nerves or the plantar metatarsal nerves. In some cases subtarsal injection of local anaesthetic solution may result in alleviation of pain from the tarsal sheath. False negative results for subtarsal analgesia may be achieved by inadvertent injection into the tarsal sheath or into a blood or lymphatic vessel.

Analgesia↗