Peroneal tendoscopy is an innovative technique that allows visualization of the tendons from the myotendinous junction to the peroneal tubercle, together with adjacent anatomic structures such as the recently unveiled vincula. Through a minimally invasive approach, it is possible to diagnose and treat several disorders, such as common tenosynovitis, accessory muscles, hypertrophic bony prominences, and thickened vincula, that can cause pain and tendon catching. Surgical morbidity and postoperative pain are significantly reduced when compared with open procedures. In this paper, the main indications for peroneal tendoscopy are discussed, the available literature is reviewed, and the surgical technique is described. Advantages of this procedure and current limitations are also presented. Anatomic and histological studies were also performed in order to verify: 1) the feasibility of peroneal tendoscopy for evaluation of peroneal tendons, using cadaver specimens; 2) the presence of nervous tissue in cadaver peroneal vincula as well as in tendoscopic vincula biopsies from patients undergoing surgery for chronic lateral ankle pain.

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Avulsion fracture of the base of the second metacarpal is an unusual injury, and the cause in the few cases reported in the literature was a fall on a volarly flexed wrist. A case of this rare injury suVered in a sport related accident by a semiprofessional rugby player is reported. It was treated with open reduction and internal fixation after failure of conservative management. (Br J Sports Med 2001;35:133-135) Keywords: avulsion fracture; metacarpal; wrist; rugby Case reportA twenty six year old semiprofessional rugby player attended the accident and emergency department complaining of pain at the dorsum of his right dominant hand. Two days previously, he had sustained a forceful hyperflexion injury of his wrist in a heavy head on tackle. Anteroposterior and lateral radiographs of his wrist were obtained but were interpreted as normal (fig 1).On review at the fracture clinic the following day, a minimally tender swelling was noticed on the dorsum of his hand at the base of the second metacarpal. The swelling was noticed to be of bony consistency and could be reduced on full dorsiflexion of the wrist. On closer inspection of the x ray films, a fracture line was suspected at the level of the base of the second metacarpal. Oblique views failed to confirm the fracture. On clinical grounds, it was decided to treat the patient as having sustained an avulsion fracture of the insertion of the extensor carpi radialis in the base of the second metacarpal.The patient was treated by applying a below elbow volar slab with the wrist in full dorsiflexion. At review after one week, the swelling was noticed to have recurred and the patient was taken to theatre. Under general anaesthetic, the hand was rotated under image intensification to establish the exact anatomy of the avulsed fragment (fig 2). Closed reduction was attempted but failed to restore the fragment. The fracture was subsequently explored through a longitudinal 5 cm incision over the osseous prominence, and the fragment was anatomically reduced and fixed with two smooth K wires (fig 3). The wrist was immobilised with a below elbow cast in neutral position for four weeks, after which the wires were removed ( fig 4) and active physiotherapy was initiated.Twelve weeks after the injury the patient had regained full range of movement of the wrist and complete function of the hand without any

IntroduzioneLe sindromi canalicolari rappresentano un quadro patologico caratterizzato da segni neurologici o vascolari legati alla sofferenza di un nervo in un suo tratto anatomico. La pratica sportiva, sempre più comune anche in età avanzata, e le posture assunte per attività lavorative sono le due cause che più hanno portato a un aumento di frequenza di questa patologia.Generalmente si tratta di compressioni legate al passaggio del nervo in un tunnel osteo-fibroso inestensibile o di una compressione estrinseca per tumori o varianti anatomiche. Appartengono alla fase di neuroaprassia e questo chiarisce come la sintomatologia non sia sempre correlabile al danno e al quadro anatomo-patologico. In questo le lesioni iniziali sono di tipo vascolare con prevalente interessamento del sistema venoso subepineurale e conseguente stasi, edema, incremento dei fe-LO SCALPELLO (2011) 25:74-78 ABSTRACT -ENTRAPMENT SYNDROMES OF PERIPHERAL NERVES IN THE LEGEntrapment syndromes are a group of peripheral nerves disorders characterized by neurological signs or vascular symptoms, due to chronic injury to the nerve as it travels from one body segment to the next. The two leading causes of this pathology are work postures and sports activities, the latter more and more common also in the elderly population. Nerve entrapment is generally caused by localized mechanical pressure from inelastic structures such as an osseoligamentous tunnel or by estrinsic compressions due to neoplasms or anatomic variations. Nerve damage is classified as neurapraxia and symptoms don't often correlate with nerve damage or histological features. Repetitive injury to a nerve may initially result in microvascular (ischemic) changes in perineural venous system (vasa nervorum) leading to endoneurial edema formation, increase in intraneural pressures and further interferenceof endoneurial microcirculation with subsequent ipoxia. Injury to the outside layers of the nerve (myelin sheath) leads to perineural fibrosis and, in more advanced stages, focal segmental demyelination related to sclerosis at the area of compression. The diagnosis is made with a thorough clinical examination, allowing to identify the nerve involved in this painful condition and the area of compression and to define the severity of the disease. EMG and, rarely, MRI or echography complete the diagnostic pathway. Operative treatment is reserved for those patients in whom conservative treatment has been unsuccessful. Timing for surgery is dependent on knowing the different anatomical entrapment sites and their specific clinical presentations. Surgical treatment in the early stages of the disease is preferable, before chronic ischemic lesions lead to permanent sensory and motor impairment.

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