Early clinical results were evaluated for 22 adult patients who had undergone an open wedge tibial osteotomy by hemicallotasis (HCO) due to medial compartment osteoarthritis. The mean age at the time of the index operation was 56 (range 33-66) years. The mean duration of follow up was 16 (range 9-23) months. The median hip-knee-ankle angle (HKA) was 169 (range 162-186) deg preoperatively and 182 (range 175-191) deg at follow up. We did not observe any early collapse of the new bone wedge. The median time to fixation was 79 (range 63-125) days. Complications included two pintract infections, and two hematomas were revised. Two patients felt pain during the phase of distraction, but the procedure could be continued after a short break. We evaluated the clinical results on the HSS, Lysholm, and Tegner activity scores. At the latest follow up examination, all of the scores had improved. Our findings demonstrate that HCO requires an exact correction, is a simple technique, and appears to reduce the chance of nerve and vascular damage.

Avulsion fractures of the anterior tibial spine are uncommon injuries, and most often seen in childhood. They can be associated with other intraarticular lesions and have, if adequately treated, a good long-term prognosis. In adults these fractures can be complicated by loss of knee extension because of the displacement of the bony fragment. This is most often as a result of non- or malunion of the displaced fragment. We review two cases of malunited fractures of the anterior tibial spine. Both patients reported persistent knee pain and loss of knee extension, and had had an anterior knee laxity for a long time. They had been treated extensively by physiotherapy. In one patient, arthroscopy in another hospital revealed no reasons for the clinical symptoms. More than twenty years after the initial trauma, both patients visited our hospital. A radiograph and a magnetic resonance imaging were respectively carried out both of which revealed a malunited avulsion fracture. According to the examinations, the patients were treated by open reduction and internal fixation, and in the follow up exploration both no longer had discomfort. Clinical and radiological features of this less common and rarely reported injury are discussed and the surgical treatment is demonstrated.

On the one hand synovial chondromatosis is a rare disorder and usually involves the knee and hip but rarely the shoulder joint. On the other hand bursal causes of impingement are rare too. We report a case of synovial osteochondromatosis presenting as chronic impingement syndrome in a 44 year old hobby tennis player. In the course of four years impingement problems and a "tumorous" growth on the outer surface attacked attraction to the patient. An MRI presented several nodular structures with sclerosis in the anteriomedial region of the shoulder joint. The mass was completely removed by operative treatment. The histological result showed a synovial chondromatosis with chronical synovitis. After the operative exstirpation of the calcified bodies the patient had no discomfort for 15 months and is now able to play tennis again.

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