We prospectively reviewed 24 patients (35 feet) who had been treated by a Scarf osteotomy and Akin closing-wedge osteotomy for hallux valgus between June 2000 and June 2002. There were three men and 21 women with a mean age of 46 years at the time of surgery. The mean follow-up time was 20 months. Our results showed that 50% of the patients were very satisfied, 42% were satisfied, and 8% were not satisfied. The mean American Orthopaedic Foot and Ankle Society score improved significantly from 52 points pre-operatively to 89 at follow-up (p < 0.001). The intermetatarsal and hallux valgus angles improved from the mean pre-operative values of 15 degrees and 33 degrees to 9 degrees and 14 degrees, respectively. These improvements were significant (p < 0.0001). The change in the distal metatarsal articular angle was not significant (p = 0.18). There was no significant change in the mean pedobarographic measurements of the first and second metatarsals after surgery (p = 0.2). The mean pedobarographic measurements of the first and second metatarsals at more than one year after surgery were within the normal range. Two patients had wound infections which settled after the administration of antibiotics. One patient had an intra-operative fracture of the first metatarsal and one required further surgery to remove a long distal screw which was irritating the medial sesamoids. We conclude that the Scarf osteotomy combined with the Akin closing-wedge osteotomy is safe and effective for the treatment of hallux valgus.

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We present a rare case of acute anterior compartment syndrome of the thigh in a rugby player with no history of trauma during the game. Decompressive fasciotomy with subsequent closure of the wound resulted in good outcome. Acute compartment syndrome of the thigh should be suspected following vigorous exercise and fasciotomy is to be performed on urgent basis.

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INTRODUCTION Skilled right-hand dominant (RHD) surgeons will have no problem cutting sutures with the right hand but most would struggle to cut with the left hand. We introduce and validate a new technique along with one published previously to improve left-hand dexterity in RHD operating theatre staff. METHODS Forty-seven RHD theatre staff from our trust's trauma and orthopaedic department were recruited for this study. Participants were first asked to cut sutures with the left hand using no particular technique (control group), followed by a new technique (new group) and then a previously published technique (Fang group). RESULTS The use of both techniques improved the participants' ability to cut with their left hand. Only 7 participants (15%) were able to cut the sutures under control conditions while 37 (79%) and 42 (89%) were successful using the new technique and the Fang technique respectively (new group: p=0.007, Fang group: p=0.0001). No significant difference was detected between the two techniques. CONCLUSIONS Both the new technique and the previously published technique to improve the dexterity of cutting sutures with the left hand in RHD surgeons are valid, effective and easy to master.

We undertook a prospective review of 24 children with spastic diplegia treated by distal hamstring fractional lengthening at the Sheffield Children's Hospital. In 14 children (24 limbs) the correction achieved (popliteal angle) was inadequate and in these patients in the operating room a further correction was attained by dividing a tight band palpated in the substance of the semimembranosus muscle. Under general anaesthetic (preoperatively) the popliteal angle (a degrees ) was measured using a goniometer, then again (b degrees ) following distal hamstring fractional lengthening and finally (c degrees ) after surgically dividing the tight band. The mean preoperative popliteal angle (a degrees ) in all 24 limbs was 65 degrees (52-90). Following the standard hamstring fractional lengthening it (b degrees ) measured 37 degrees (35-50) and after division of the tight band it (c degrees ) measured 15 degrees (10-20). The reduction in popliteal angle following release of the tight band (proximal aponeurosis) was statistically significant (P<0.05). We undertook a cadaveric examination of 22 lower limbs and confirmed in all the cases that this band was the proximal aponeurosis of the semimembranosus muscle. The proximal aponeurosis is a well defined band located at the anterior aspect of the semimembranosus muscle where it arises from the tendon of the proximal attachment. It is separate from the distal aponeurosis. Division of the proximal aponeurosis during fractional lengthening of the distal hamstring in patients with cerebral palsy results in a significant reduction in the flexion deformity.

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