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Background: Chronic Achilles tendon ruptures are uncommon and increase long-term morbidity when untreated. There is no standard treatment for this condition. Methods: Chronic Achilles tendon rupture was repaired in 10 patients by harvesting the flexor hallucis longus tendon (FHL) using a minimally invasive technique. It was then transferred to the calcaneus and the remnant used to bridge the gap for reconstructing the Achilles tendon itself. The patients were assessed using the American Orthopaedic Foot and Ankle Score (AOFAS) Ankle-Hindfoot Scale. Results: Patients were evaluated postoperatively to assess pain, function, and alignment of the ankle and hindfoot. Average follow-up time was 30.9 months (range = 17-43 months). The average postoperative AOFAS score was 78.5 (range = 54-94). The average postoperative score for pain was 33.5 out of 40; for function, 38.7 out of 50; and for alignment, 6.3 out of 10. A single surgical site infection requiring Incision and Drainage (I&D) was the only operative complication noted. No patient developed a significant deformity of the hallux after transfer. Conclusions: FHL transfer using a minimally invasive harvest for the treatment of chronic Achilles tendon ruptures produces good to excellent outcome measures as judged by an AOFAS score of 75 or greater while minimizing risk to the medial neurovascular bundle. Levels of Evidence: Case series, Level IV: Retrospective

Background: Segmental or multi-fragmentary phalangeal fractures causing bone loss are rare but difficult injuries to treat. Aims: This report evaluates a tricortical graft from the proximal ulna for both suitability of use and donor site morbidity. Methods: The proximal part of the subcutaneous border of ulna was exposed in two cadavers and a 1 cm graft chamfered at either ends was harvested. Thus, a crater measuring 2 cm was created in the proximal ulna. The proximal phalanx of one finger (different for each cadaver) was exposed by a dorsal tendon splitting approach. A segment of the midshaft of the proximal phalanx measuring 1 cm was removed and the graft taken from proximal ulna was interposed and checked for size and fit. The ulna was then disarticulated at the elbow and osteotomised proximal to the wrist. Opposite intact ulna was also harvested in the same manner. The ulna were mounted on a materials testing machine (Instron) and subjected to four-point loading to failure. Results: The shape of the tricortical graft was suitable to bridge the segmental defects in all the phalanges except the thumb phalanx, where it left a step in the dorsoventral plane. In all other phalanges the cortex allowed the flexor and extensor tendons to glide smoothly. The mean load to failure of the intact ulna was 1138.35 N (range 1025.7-1251, SD ¼ 112:65) and the donor ulna failed at an average of 519 N (range 408.25-629.75, SD ¼ 110:75). Thus the donor ulna had 46% strength compared to the intact ulnar. Discussion: Ulnar tricortical graft provides a good anatomical match for segmental defects of proximal phalanges of fingers. The donor bone retains almost half the original strength. This contrasts with studies on the radius for mandibular reconstruction where 82% of the strength was lost resulting in frequent fracture. However, care may need to be taken to protect the donor site. Conclusion: The ulnar is a useful and accessible donor for tricortical graft for use in proximal phalanx reconstruction.

harvested at 2 weeks. A test rig was used to apply a defined tensile regime in 1% increments to the tendon adhesions. We visualized the movement of fluorescently labelled nuclei (stained with ethidium homodimer) confocally in real-time in 2D and 3D. The adhesions were also assessed macroscopically and with ''pullout'' tensile mechanical testing. Cellular organization, adhesion orientation and local strain were assigned values using image analysis software. Results: Different adhesion subtypes (shearing, stretching, disorganized and tearing) were noted in both the mobilized and immobilized adhesions. The mobilized adhesions were more organized and exhibited higher local strain than their immobilized counterparts. Conclusion: Our confocal microscopy assessments, using fibroblast nuclei as markers, give us an accurate measure of strain and adhesion disorganization. We have developed a model for the quantitative assessment of therapies (which may be introduced into this system) in modifying the local characteristics of tendon adhesion.Background: We studied the variation of relationship between the origin of flexor digitorum superficialis muscle (FDS) and tendons attached to the proximal phalanx in each digit and the anatomy of musculoaponeurotic system of its origin. Patients and methods: Eighteen upper extremity cadavers were investigated and the 3-D anatomy of the FDS origin was examined. Divided into two groups, the independent muscle group was forming the separated origin of FDS. On the other hand, partially or completely mixed muscle fibres of other digits was called the dependent muscle group. Results: The rate of independent/dependent muscle in each origin of FDS was 0/18, 16/2, 8/10 and 0/18 in the order of 2nd to 5th digit. An unusually, intermediate tendon attached to its proximal and distal muscle fibre concurrently was observed in all cases. The origin of FDS showed a large surface musculoaponeurotic system and was seen in a fan-shape array. Conclusion: In many cases, FDS was a dependent muscle system but relatively independent especially in the middle finger. The origin of FDS was formed in a 3-D shape to expand the surface area for its thick muscle origin. Unlike other muscles, the FDS had intermediate tendons, which did not connect to origin and distal tendon.Background: The morphological features of proximal phalanges have been studied in great detail. Biomechanical characteristics are less well defined. They are of obvious importance in designing prostheses and implants as well as in optimizing rehabilitation regimes. We studied the flexural loading characteristics of cadaveric proximal phalanges using a three point loading pattern. Materials and methods: Thirty cadaveric proximal phalanges were harvested. Their external dimensions were measured with calipers at the point of loading. They were mounted on a custom made rig and subjected to three point load to failure on a Universal testing (Instron) machine. Crosshead speed was set at 1, 5, and 10 mm/min for 10 phalanges each. Load at yield and stres...