R ecurrent dislocation of peroneal tendons is uncommon and there are few reports of the long-term results after repair. The Singapore operation, first described in 1985, is an anatomical repair based on the Bankart-like lesion seen in the superior peroneal retinaculum.We reviewed 21 patients after a mean follow-up of 9.3 years, and found no recurrence. Eighteen had good functional results and had returned to their previous levels of vocational and sports activities. The three fair results were due to painful scars or neuromas.J Bone Joint Surg [Br] 1998;80-B:325-7. Received 19 August 1997; Accepted 3 October 1997 In 1985 we reported a new operation for the repair of recurrent dislocation of peroneal tendons, 1 describing the Bankart-like lesion in which the superior peroneal retinaculum is stripped from its fibular attachment. The persisting pouch allowed easy dislocation of the peroneal tendons, but reattachment through drill holes in the fibula can prevent redislocation. We now report the long-term results. Patients and MethodsBetween 1981 and 1991, a total of 22 patients had the Singapore operation, excluding those with associated foot and ankle fractures. One patient was lost to follow-up, leaving 21 for review. There were 18 men and three women, with a mean age at operation of 24 years (16 to 36). Ten were army personnel, five were students, and six sedentary workers. The common causes of dislocation were sports or combat-training injuries, and few patients had treatment for the initial injury. They all had pain and instability due to recurrent dislocation of the tendons, and were seen at a mean interval of eight months after injury. Clinical examination showed bow-stringing of the peroneal tendons on dorsiflexion and eversion of the foot and radiographs revealed no avulsion fractures involving the lateral malleolus.At operation, the lesion was confirmed and repaired by the same technique 1 using four sutures at 1 cm intervals to replace the anterior edge of the retinaculum (Fig. 1). A below-knee plaster cast in the neutral position was retained for six weeks after which physiotherapy was started. Mild to moderate sporting activities were allowed after another six weeks, but avoidance of contact sports was advised for a further period of six months. At review, we assessed recurrence, pain, stability, and function in vocational and sports activities, using a score modified from other systems 2,3 (Table I). Patients were examined for tenderness, scarring and neuroma formation and the range of movement of the ankle and subtalar joints was recorded.

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Isolated distal radio-ulnar joint dislocations are rare and commonly missed on radiographs. A young male presented with severe pain and deformity of the left wrist, following a collision whilst playing rugby. This was easily diagnosed using plain radiographs, and the initial attempted reduction methods in the Emergency Department failed. The patient was subsequently anaesthetised in theatre, yet reduction by an accepted method of palmar to dorsal pressure over the interosseous membrane with simultaneous distraction of the wrist failed. A further attempt to manipulate the dislocated ulnar head was successful, with the same force applied whilst the wrist was maximally flexed and pronated – thereby avoiding an open reduction. The patient was asymptomatic at final follow-up, over one year later. This technique has not previously been described in the literature and may be used in similar injuries in the future.