The upper three-quarters of the fibula is commonly used as a non-vascularised autograft. Subsequent to this isolated weakness of extensor hallucis longus may occur. We have studied 26 patients in whom the upper and middle thirds of the fibula had been harvested as a graft through Henry's posterolateral approach. Isolated weakness of extensor hallucis longus was found after operation in ten patients but not in the remainder. EMG and nerve-conduction studies confirmed injury of the nerve to extensor hallucis longus in those with weakness. We dissected 40 cadaver limbs and found that those in which the nerve to extensor hallucis longus ran close to the fibular periosteum were at risk. The injury is mostly incomplete and recovery occurs within four to six months.

Introduction:To compare the efficacy, safety, and tolerability of transdermal patches of diclofenac sodium with oral diclofenac sustained release (SR) in patients of chronic musculoskeletal MSK pain conditions.Materials and Methods:The eligible patients were given either transdermal diclofenac patch or tablet diclofenac SR. Pain was assessed at 2 and 4 weeks using a visual analog scale. Adverse events were recorded. Patients with 18–65 years old of either gender with score of ≥4 on a 11-item numeric rating scale-numeric version of visual analog scale for pain with diagnosis of primary osteoarthritis (OA) of the knee or hand of at least 3 months duration, with independent radiological confirmation of OA or having pain associated with other MSK conditions such as soft-tissue rheumatism, cervical and lumbar back pain, and fibromyalgia, of at least 3 months duration were included in this study.Results:Transdermal diclofenac diethylamine patch and tablet diclofenac sodium sustained release (SR) do not significantly differ in the reduction of numerical rating scores at the end of 4 weeks (P = 0.8393).Conclusion:Transdermal diclofenac was equi-efficacious as tablet diclofenac sodium SR in reducing pain due to chronic MSK pain conditions.

Anterior cruciate ligament (ACL) tibial avulsion occurs predominantly in children and young adults. It is seen in association with injuries due to hyperextension usually involving movements that are similar to riding a bicycle. Bony ACL avulsion is associated with severe restriction of knee range of motion, swelling, inability to bear weight, and continuous pain. Acute swelling does not allow a conclusive clinical examination. Bony ACL avulsion from the tibial side has been treated by various methods ranging from conservative management to a wide range of operative procedures. The various operative procedures that have been described require challenging operative skills, time, and resources, making these techniques demanding and technically challenging. We describe a technique for the treatment of Meyers-McKeever type II, III, and IV bony tibial ACL avulsions that uses regular anterolateral and anteromedial portals with an additional transpatellar portal. The avulsed fragments along with the ACL are held and buttressed with the help of FiberWires and fixed with the intra-articular portion of the proximal tibia. The technique is performed in an all-inside manner and is easy to master, even for beginners.A nterior cruciate ligament (ACL) avulsion injuries from the tibial side are seen most commonly among children and young adults. 1 They are commonly associated with sports injuries like those usually seen during hyperextension combined with a rotational injury of the knee. 2 ACL avulsion from the tibial side can be extremely debilitating because it limits daily activities, restricts range of motion, and is commonly found in association with continuous pain with or without weight bearing, knee swelling, and instability. Per the Meyers and McKeever classification, 3 types II, III, and IV are displaced avulsion fracture injuries for which one should consider intervening. It is important to realize that however small a tibial avulsion fragment may be, it can be very limiting to the patient. If not addressed adequately, this avulsion is associated with joint laxity, constant pain, fracture nonunion, and loss