Transfer of the FHL for reconstruction of chronically ruptured Achilles tendons is effective, safe and easily performed in patients with low-to-moderate demands.

Neglected fracture dislocations of ankle are rare in western countries. Failure to achieve anatomic reduction is associated with a poor prognosis. We present a case of a patient with a neglected Weber B fracture of the fibula with postero-lateral subluxation of the ankle. In theatre, the subluxation could not be reduced, and a posterior and lateral soft tissue release was performed. Granulation tissue was removed from the medial gutter. The fibular fracture was reduced and fixed with a six-hole dynamic compression plate. Post-operative radiographs was satisfactory and the patient was followed up for 12 months with full range of movement and function of the joint. In our case, correction was not obtained by osteotomy of the lateral malleolus alone, and medial and posterior soft tissue release was required. This was due to disruption of the deltoid ligament and posterior tibiofibular ligament and the associated scar tissue. Previous studies have shown that, if anatomic reduction is achieved, results with delayed surgery can be as good as those obtained with immediate surgery. Surgically correcting an old fracture dislocation is a difficult undertaking due to soft-tissue contractures and malunited fractures. It is important to preserve as much soft tissue attachments and periosteum to prevent avascular necrosis.

Ann R Coll Surg Engl 2003; 85is pulled partially into the umbilical port under vision, while the camera is being withdrawn. The Hassan's umbilical port is then removed and the ends of the silk are grasped with artery forceps and pulled, thereby delivering the bag to the surface of the wound (Fig. 2). The bag and its contents may then be retrieved safely leaving the wound completely protected.Discussion: Most retrieval bags have a tendency to tear or the pulling grasper may slip during extraction.2 Tying a silk suture onto the BERT bag enables it to be pulled to the surface quickly and safely. The need for an additional 10-mm epigastric port or a 5-mm laparoscope to view the gallbladder during retrieval is thus eliminated. We have found this method of gallbladder retrieval simple, safe and inexpensive. We recommend its routine use during '5-mm' laparoscopic cholecystectomy. OrthopaedicsThe flexor hallucis longus tendon transfer for chronic tendo-achilles ruptures revisited RB Dalal, M Zenios Department of Orthopaedic Surgery, Stepping Hill Hospital, Stockport, UKBackground: Chronic or neglected ruptures of the tendoachilles are difficult to deal with. We report excellent results following three operations in two elderly patients on longterm steroid therapy, using the flexor hallucis longus tendon.

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