The accessory navicular is occasionally the source of pain and local tenderness over the instep. If conservative measures fail, surgical treatment may be required and the results of 62 operations to one or both feet in 47 patients are reported. Twenty-six patients were treated by the Kidner operation, in which the main insertion of the tibialis posterior is re-routed; in the remaining 21 the ossicle was merely excised. Excision was as effective as the Kidner technique, provided that the medial surface of the main navicular bone was contoured to prevent any residual prominence. Both procedures were successful in relieving symptoms in the majority of cases and failures resulted from errors in the selection of patients or in the surgical technique. Correction of any associated flat foot was secondary to growth and maturation of the foot rather than to the operation; hence the Kidner procedure does not confer any particular advantages over simple excision.
After congenital dislocation of the hip, Perthes' disease and some other conditions, the femoral neck may be short and the greater trochanter in a relatively proximal position. Distal transfer of the greater trochanter is an effective and relatively simple operation to correct this deformity. We have reviewed 26 patients (27 hips) at a mean follow-up of eight years. Pain relief and improvement
The records of 1 10 cases of ulnar neuritis in 100 patients have been reviewed an average of 4.4 years after anterior transposition, or release of the aponeurosis. Seventy of the patients were reviewed personally. In over half the cases no precipitating cause was apparent. At operation the nerve was constricted by the flexor carpi ulnaris aponeurosis in fifty cases but in twenty-five no abnormal pathology was found. Recovery was greatest when operation was performed within three months of the onset of symptoms. In those cases where no abnormality was found, and those in which adhesions in the postcondylar groove involved the nerve, simple release was less effective than anterior transposition. It is therefore recommended that release be restricted to patients with a short history and with an obvious aponeurotic constriction unaccompanied by adhesions. Anterior transposition is the operation of choice where no abnormality is seen or where the nerve is dislocated, compressed or tethered proximal to the
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