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In patients with Freiberg disease, intra-articular dorsal wedge osteotomy restores congruity of the metatarsophalangeal joint, and fixation with absorbable pins provides adequate fixation and avoids a second procedure for implant removal.

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Therapeutic study, level III.

We treated 32 displaced mallet finger fractures by a two extension block Kirschner-wire technique. The clinical and radiological outcomes were evaluated at a mean follow-up of 49 months (25 to 84). The mean joint surface involvement was 38.4% (33% to 50%) and 18 patients (56%) had accompanying joint subluxation. All 32 fractures united with a mean time to union of 6.2 weeks (5.1 to 8.2). Congruent joint surfaces and anatomical reduction were seen in all cases. The mean flexion of the distal interphalangeal joints was 83.1 degrees (75 degrees to 90 degrees ) and the mean extension loss was 0.9 degrees (0 degrees to 7 degrees ). No digit had a prominent dorsal bump or a recurrent mallet deformity. We believe that this technique, when properly applied, produces satisfactory results both clinically and radiologically.

We performed one-stage lengthening using intercalary autogenous bone graft in 34 metatarsals and seven proximal phalanges in 21 patients with congenitally short metatarsals. At operation, in order to decrease the tension in the surrounding soft tissues, we gradually distracted the osteotomies of the affected bones for 20 to 30 minutes. The patients, all women, were followed up for a mean period of 2.1 years (1 to 6.5).The average gain in length for the 34 metatarsal procedures was 14 mm (6 to 21), equivalent to an increase of 32% (11 to 51), and for the seven proximal phalangeal lengthenings 8 mm (5 to 11), an increase of 54% (47 to 65). There was no evidence of neurovascular impairment.The technique of gradual distraction during operation is simple and effective. It overcomes the disadvantages of one-stage lengthening such as a small gain in length and neurovascular damage. Congenital brachymetatarsia describes shortening of the metatarsal bone caused by premature closure of the epiphysis. The fourth toe is most commonly involved, although any or multiple metatarsals may be affected. The deformity has a strong female predilection with a reported sex ratio of 98:4.1 Cosmesis may be a problem, especially in young women. Surgical correction with autogenous bone graft from the calcaneus was first reported in 1969 2 and since then many techniques have been described. The most widely-used procedures are either one-stage lengthening with intercalary bone graft 1-3 or gradual lengthening by callotasis. [4][5][6] Each has its advantages and disadvantages. One-stage lengthening needs a shorter period to bony union and has less morbidity, but produces a proportionally smaller increase and more neurovascular complications than the gradual procedure. 7,8Patients and MethodsBetween 1989 and 1995, we performed 41 one-stage lengthenings (34 metatarsals and seven proximal phalanges) using intercalary autogenous bone graft in 21 patients with congenital brachymetatarsia. To achieve the optimal length of the toe, six proximal phalanges were lengthened with the metatarsal of the same ray. All 21 patients were women and their average age was 16 years (10 to 36). All complained of the appearance of the short toe(s), and ten had occasional pain around adjacent metatarsal heads when walking. In 11 patients the condition was unilateral with the fourth metatarsal involved in ten and the first metatarsal in one. Of the ten patients with bilateral involvement, six showed shortening of the fourth metatarsal, two of the first and fourth metatarsals, one of the first, third and fourth metatarsals, and one of the fourth metatarsal and adjacent proximal phalanx. In 19 patients, we used intercalary autogenous iliac-bone grafts (Figs 1 and 2). In two patients with bilateral short first and fourth metatarsals, the second and third metatarsals were shortened and the excised bone used to lengthen the fourth metatarsal (Fig. 3). There was a family history in three patients. Four patients had associated brachymetacarpia which was bilateral in two and...

Despite a recent increase in the recognition of osteoporosis in patients with fragility fractures, our review of this national cohort indicates that patients with a wrist fracture are less likely to be evaluated and managed for osteoporosis than those with a hip or spine fracture by physicians who are responsible for treating symptomatic fractures. Additional studies and intervention programs are necessary to improve this care gap, beginning with physicians who are responsible for fracture treatment.