Oblique osteotomy through the distal half of the shaft of the metatarsal. It is essential that the distal fragment should slide up on the proximal fragment and not angulate.

There is a higher risk that the tendon of extensor pollicis longus will rupture in undisplaced Colles' type of fracture than in those which are displaced. This difference in incidence is due to the integrity of the extensor retinaculum in undisplaced Colles' type of fracture causing the tendon to be held tight against the fracture callus in the floor of the tunnel which may result in an attrition rupture. In the displaced Colles' fracture the extensor retinaculum is torn from the bone and thus permits the tendon to escape from contact with the fracture site.

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A review is presented of 508 feet in 310 patients after telescoping osteotomy of the lesser metatarsals for metatarsalgia. The patients were predominantly female (80%), with a mean age of 55 years; the range of follow-up was 1 to 12 years. In 22% of the patients the metatarsalgia was associated with rheumatoid arthritis. Improvements in assessment and modifications in technique are reported and the management of complications is discussed. The results show that telescoping osteotomy for established cases of pressure metatarsalgia is a simple and reliable operation. Permanent relief of symptoms can be expected in over 80% of patients.

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