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The purpose of this anatomical study was to explore the morphological variations of the semitendinosus and gracilis tendons in length and cross-section and the statistical relationship between length, cross-section, and body height. We studied the legs of 93 humans in 136 cadavers. In 43 specimens (46.2%) it was possible to harvest the tendons from both legs. We found considerable differences in the length and cross-section of the semitendinosus and the gracilis tendons with a significant correlation between the two. A correlation between the length of the femur, reflecting height, and the length of the tendons was only observed in specimens harvested from women. The reason for this gender difference was unclear. Additionally, there was a correlation between the cross-sectional area of the tendons and the length of the femur. Surgeons should be aware of the possibility of encountering insufficient length of tendon when undertaking reconstructive surgery as a result of anatomical variations between patients.

Background: Posterolateral tibial plateau shear fractures often require buttress plating, which can be performed through a posterolateral approach. The purpose of this study was to provide accurate data about the inferior limit of dissection.Methods: Forty unpaired cadaver adult lower limbs were used. The anterior tibial artery was identified because it coursed through the interosseous membrane. The perpendicular distance from the lateral joint line and fibula head to this landmark was measured.Results: The anterior tibial artery coursed through the interosseous membrane at 46.3 6 9.0 mm (range 27-62 mm) distal to the lateral tibial plateau and 35.7 6 9.0 mm (range 17-50 mm) distal to the fibula head.Conclusions: Displaced posterolateral tibial plateau fractures require anatomic reduction and stabilization with a buttress plate. This can be achieved by gaining access to the posterolateral tibial cortex. The distal limit of this dissection can be as little as 27 mm distal to the lateral tibial plateau. Dissection in this region should be carried out with caution.

We have investigated the anatomy of the proximal part of the ulna to assess its influence on the use of plates in the management of fractures at this site. We examined 54 specimens from cadavers. The mean varus angulation in the proximal third was 17.5 degrees (11 degrees to 23 degrees ) and the mean anterior deviation 4.5 degrees (1 degrees to 14 degrees ). These variations must be considered when applying plates to the dorsal surface of the ulna for Monteggia-type fractures. A pre-operative radiograph of the contralateral elbow may also be of value.

In most cases, breakage of an orthopaedic instrument is not a problem. Any instance of instrument breakage should be fully documented in the surgical report.

The final result of the treatment of distal intra-articular radius fractures depends both on the accuracy of the fracture reduction and on the presence of additional carpal injuries. In particular, lesions of the intrinsic ligaments usually lead to severe degenerative damage of the wrist joint if they are missed primarily. With the introduction of wrist arthroscopy, these tears can be evaluated and treated earlier. Since 1993 arthroscopically assisted treatment has been performed in 23 patients with distal intra-articular fractures of the radius (mainly C-fractures according to the AO classification system or group VII and VIII fractures according to Frykman). Scapholunate (SL) tears were found in 11 patients (47.8%), 7 of whom showed marked instability intraoperatively and were stabilised at the time of surgery.

T he anatomy of the mortise of the Lisfranc joint between the medial and lateral cuneiforms was studied in detail, with particular reference to features which may predispose to injury. In 33 consecutive patients with Lisfranc injuries we measured, from conventional radiographs, the medial depth of the mortise (A), the lateral depth (B) and the length of the second metatarsal (C). MRI was used to confirm the diagnosis. We calculated the mean depth of the mortise (A+B)/2, and the variables of the lever arm as follows: C/A, C/B and C/mean depth. The data were compared with those obtained in 84 cadaver feet with no previous injury of the Lisfranc joint complex. Statistical analysis used Student's two-sample t-test at the 5% error level and forward stepwise logistic regression. The mean medial depth of the mortise was found to be significantly less in patients with Lisfranc injuries than in the control group. Stepwise logistic regression identified only this depth as a significant risk factor for Lisfranc injuries. The odds of being in the injury group is 0.52 (approximately half) that of being a control if the medial depth of the mortise is increased by 1 mm, after adjusting for the other variables in the model. Our findings show that the mortise in patients with injuries to the Lisfranc joint is shallower than in the control group and the shallower it is the greater is the risk of injury. J Bone Joint Surg [Br] 2002;84-B:981-5. The tarsometatarsal joint of the foot (Lisfranc joint) consists of the distal row of tarsal bones, the medial, intermediate , and lateral cuneiforms and the cuboid, which articulate with the bases of the five metatarsals. It is S-shaped and is divided into three columns, with three distinct arches. 1,2 Of the three arches, the horizontal arch is anchored by the base of the second metatarsal, which is recessed into a 'mortise' between the medial and lateral cuneiforms (Fig. 1), and stabilises the joint. 2,3 Intermetatarsal and thin dorsal ligaments connect the second, third, fourth and fifth metatarsals, and the tarso-metatarsal joint is further stabilised by the strongest of the ligamentous structures, the plantar tarsometatarsal ligaments. There is no intermetatarsal ligament between the bases of the first and second metatarsals. The main stabilis-ing structure of the tarsometatarsal joint is a Y-shaped interosseous ligament (Lisfranc's ligament). This extends on the plantar surface from the lateral aspect of the medial cuneiform to the medial aspect of the base of the second Fig. 1 Anatomical specimen of a left foot. It was dissected in an oblique axial plane showing the position of the second metatarsal base in the mortise between the medial and lateral cuneiform.