Ankle sprains: surgical treatment for recurrent sprains. Report of 10 patients treated with the Chrisman-Snook modification of the Elmslie procedure.

A group of 10 patients (3 women and 7 men; 17 to 57 years old, average 23.9; mean, 21 years) was evaluated preoperatively and postoperatively following surgical repair with a modification of the Elmslie procedure (i.e., by using one-half of the tendinous portion of the peroneus brevis ligament to reconstruct the anterior and middle fasciculi of the lateral ligament). The patients were athletes who participated in bicycling, boxing, tennis, hockey, basketball, football, soccer, or a combination of sports. Each patient gave a history of spraining the ankle numerous times. Stress films were obtained preoperatively and postoperatively. The talar tilt was generally reduced in postoperative films (average preoperatively, 12.5 degrees; average postoperatively, 5.6 degrees). We conclude that the Elmslie procedure, as modified by Chrisman and Snook, is simpler to perform than the Watson-Jones procedure and has provided the majority of our patients with satisfactory results.

Contribution of the epiphyses of the greater trochanter to the growth of the femur.

We have demonstrated the interaction of the capital femoral epiphysis and the greater trochanteric epiphysis in rats to give length and shape to the proximal femur. These findings have practical applications in the treatment of congenital coxa vara and other disease entities of the femoral head.

Traumatic sternoclavicular dislocation.

Traumatic dislocations of the sternoclavicular joint may be anterosternal or retrosternal. Anterior dislocation is due to forces which retract and depress the clavicle. Posterior dislocation is due to either direct force on the medial end of the clavicle or to a force acting on the posterolateral aspect of the shoulder. From 1950 to 1974 we treated 16 patients with traumatic complete sternoclavicular dislocations. Twelve patients were followed and their cases are discussed. Treatment may be closed or open. In some cases we did not attempt reduction because it may be very difficult to maintain and dislocation may recur. Open reduction is extremely difficult and not recommended unless a serious intrathoracic problem also exists. Based on our cases, we conclude that stability of the sternoclavicular joint is not necessary to ensure normal function of the involved limb. The residual prominence of the medial portion of the clavicle does not cause pain and does not interfere with chest or shoulder function.

Articular Fractures of the Dome of the Talus.

In brief Osteochondral fractures of the talar dome are often overlooked because the symptoms are similar to ankle sprains. The most common site of fracture is on either the superolateral or superomedial margin of the dome. Lateral lesions are caused by inversion and dorsiflexion of the ankle, while medial lesions result from inversion and plantar flexion. Careful inspection of x-ray films is the only way to diagnose an acute injury. Surgical treatment is usually required to avoid a long period of immobilization.