314

BRIEF

REPORTS

take full weight and, if socially possible, from hospital. The fixator was removed radiographic callus was visible, usually

were discharged when adequate at 1 2 to 16 weeks.

knee 2.9% Three revision

amputation. incidence had with loose

Lettin in their femoral custom-made

et a! (1984) series of components

reported six cases, knee replacements. and required and Merke!

Results. All five fractures united in good position with no refractures after a minimum follow-up of two years. No knee replacements have loosened as a result of the

prostheses. used femoral external fractures

Johnson three of

(1986) successfully 36 supracondylar

fixation for occurring

fracture, and the patients have regained their original 0#{176} after to 80#{176} range of knee movement. very They each had minor pin-track infections, requiring weeks, treatment by simple dressings and oral antibiotics, but no pin was removed and all the fractures healed well type after fixator removal. Illustrative case. An 86-year-old a spiral Internal screws fracture fixation were removed consolidation Late femoral above failed and her (Fig. were shaft woman knee 2). The a Portsmouth fell and sustained prosthesis plate and fixator (Fig. accessible applied. 1).

resurfacing total knee replacements. Our use of the Portsmouth external fixator has been successful with sound union in all five patients by 16 and no major complications or refractures. This of management
in any party

is recommended.
form have been related directly received or will be received or indirectly to the subject from a of this

No benefits commercial article.

REFERENCES

Edge AJ, Denham

complicated Grimer

Union and Discussion.

very satisfactory fracture after

(Fig. 3). a Stanmore management (1984) treated to to unite. fixator, above-

RA. tibial knee

The Portsmouth fractures. Injury MRK, Edwards replacements. TG, Scales replacements. Supracondylar J Bone Joint

method of external 1979; 1 1 :13-18. AN. The long-term J Bone Joint Surg JT. The J Bone long-term Joint Surg of the 1986;

fixation

of

total knee replacement remains a difficult problem. Grimer, Karpinski and Edwards one case by internal Another was treated but developed infected fixation, by traction nonunion but and

RJ, Karpinski Stanmore total 66-B :55-62.

results of [Br] 1984: results of [Br] 1984; femur after 68-A :29-43.

Lettin

it failed an external and came

AWF, Kavanagh Stanmore total knee 66-B :349-54. total KD, Johnson EW. knee arthroplasty.

Merkel

fracture Surg [Am]

HOW

THE

SIMMONDS-THOMPSON

TEST

WORKS

B. W.

SCOTT,

A. AL

CHALABI Calcaneal tendon

Testing for rupture of the calcaneal tendon by squeezing the calf was first described by Simmonds (1957). Thompson earlier in Thompson (1962) had observed 1955. It is accepted test is pathognomonic this effect some two years that the Simmondsfor complete rupture, with a of the

Gastrocnemius

Soleus

but its mechanism is not clear. Investigation. We used an ultrasound machine 7.5 MHz linear probe to examine dynamic images calf in two young adults. With transverse seen to move at the ankle. but no proximal and squeeze Doherty test became the gastrocnemius corresponding was clearly to the movement

compression, proximally, The so!eus movement (1962) had

was more difficult to visua!ise, of the muscle could be seen. By found, contrast, in cadavers, Thompson that the

positive
Fig. 1

B. W. Scott, FRCS, Orthopaedic Registrar A. Al Chalabi, FRCS, Associate Specialist Coventry and Warwickshire Hospital, Stoney CV1 4FH, England. Correspondence Leeds L58 1RU, to Mr B. W. Scott England. and

Stanton

Road, Drive,

Coventry Roundhay,

at 2 St Margarets

(no plantar To elucidate

flexion) when the this we dissected

so!eus alone was divided. three fresh above-knee the one

1992 British Editorial Society ofBone 0301-620X/92/2R42 $2.00 JBoneJoint Surg[Br] 1992; 74-B:3l4-5.

Joint

Surgery

amputation specimens tendon from the soleus calcaneum where the

THE

and separated the gastrocnemius down to about 10 cm above fibres became blended into
OF BONE AND JOINT

JOURNAL

SURGERY

BRIEF

REPORTS

315

tendon. soleus bow

1).

Squeezing causing the

the

calf

was

seen

to deform

the tendon

fleshy to (Fig. soleus 1 cm

principally dinous of the unit. calf

reflects Plantar tendons of the

in any party form related

the integrity

of the soleus

musculotenbowing proximal

overlying

gastrocnemius

away There

from the tibia resulting in plantar was no longitudinal movement muscle bellies moved confirming the soleus

flexion of the about

flexion is caused and, to a less bellies

have been directly

by posterior extent, by

displacement
No benefits commercial article.

of the gastrocnemius.
received or will be received or indirectly to the subject from a of this

while

the gastrocnemius

proximally, When

our ultrasound findings. tendon was divided the

proximal

movement of the gastrocnemius, due to direct pressure on the tapering bellies, produced only a small amount of plantar flexion. Division of the gastrocnemius tendon alone did not prevent full p!antar flexion on calf compression. Conclusion. The result of the Simmonds-Thompson test

REFERENCES Simmonds FA. Practitioner The diagnosis of 1957; 179 :56-8. the of ruptured the tendo Achilles Achillis. tendon. Acta The Orthop

Thompson
Scand
Thompson

TC. A test for rupture 1962; 32 :461-5. TC, Doherty JH. clinical diagnostic

a new

Spontaneous rupture of tendon test. J Trauma 1962 ; 2:126-9.

of Achilles:

PROMINENCE

OF

THE

CALCANEUS:

LATE

RESULTS

OF

BONE

RESECTION

H. M. HUBER

Undue

prominence

of the (Fig. and radical the

posterosuperior

edge

of the

Ofthese,

98 patients

completed

a questionnaire

after

calcaneal tuberosity irritation by footwear, (1927) recommended calcaneus when is uncertainty removed. Patients and about methods.

1) can lead to mechanical to painful bursitis. Haglund resection ofthis part of the treatment failed, which but should there be 120 of bone 1970 to 1985

conservative amount From

an average of 8.3 years (3 to 18). The 18 patients with some residual symptoms were also reviewed clinically and radiologically. We recorded the height of any bony ridge left after resection, measuring from the upper margin which the of the insertion of the ca!caneal is seen on a lateral radiograph tendon (Fig. as a thickening 2), of

we treated

cortex.

Figure 1 - Prominence ofthe posterosuperior edge of the calcaneal tuberosity. The insertion of the calcaneal tendon is marked by a thickening of the cortex. Figure 2 - The height of the ridge is the distance from the calcaneal tendon insertion (A) to the posterosuperior ridge of the calcaneus (B). The shape of the surface after complete removal of the calcaneal ridge (C).

Fig.

Fig.

patients at the Orthopaedic University Hospital Ba!gnist in Zurich by resection of the posterosuperior calcanea! tuberosity. Their average age was 15.5 years (12 to 32); 72 were female, 48 were male and most had bilateral operations. We used a lateral approach 1 to 2 cm anterior to the calcaneal tendon (Inman 1973).

Results. problems two had The

Eighty of the 98 patients were completely free of in both feet, 14 had minor residual complaints, no improvement and two had been made worse. height of the ridge pre-operatively postoperatively with complete in all 98 it was relief of six had

average

patients was 28 mm (24 to 32); 8 mm (0 to 32). In the 80 patients

symptoms the mean height was 7 mm (0 to 13). Of the 18 patients with residual symptoms,
H. M. Huber, MD, H#{244}pital de la Ville, Switzerland. Orthopaedic Surgeon Rue du Chasseral, CH-2300 La Chaux-de-Fonds,

1992 British Editorial Society of Bone 0301-620X/92/2R47 $2.00 J Bone Joint Surg [Br] 1992; 74-B :315-6.

and

Joint

Surgery

painful superficial scars. Seven had persistent pressure problems : five of these had an average postoperative ridge height ofl8 mm (15 to 32), and two had calcification in the had resected zone. tendinitis The due other five patients with pain calcaneal to too steep a resection.

VOL.

74-B, No.

2, MARCH

1992