The broken bone without a fracture: a case report

A case is reported of a 76-year-old lady who complained of a painful knee following a road traffic accident. Radiography revealed bone fragments behind the knee but no immediate source was obvious.     

Burn injury in the aged patient

It is a tragedy when an aged patient dies after sustaining a minor burn. Although many reported series illustrate the poor prognosis of burn injury in the elderly, the number of patients studied is often small. In a 10-year-period, 276 patients aged over 60 years were admitted to the Wessex Regional Burn Centre following acute burn injury. These patients represented 16 per cent of all acute burn admissions, and were studied in a retrospective review. Various data on mortality and burn size incidence are presented for this traditionally regarded high risk group.     

Destructive burns: Some orthopaedic complications

Deeply destructive burns are uncommon and no surgeon has a very extensive experience of them. In such cases, where no set rules of treatment have yet been established, we still have to feel our way towards the recovery of form and function, sensitive to the patient's physical and emotional responses and guided by general surgical principles.The orthopaedic complications of these severe lesions are discussed under the following headings: the destruction of the central extensor mechanism of the knee joint, disordered growth, septic arthritis, dislocations, the wasted calf, new bone formation and amputations.     

Dislocation of the scaphoid and lunate bones without fracture: a case report

A patient with a dislocation of both lunate and scaphoid bones is described. The position of the hand at the moment of injury seems to have been dorsiflexion and radial deviation. A mechanism for this injury is proposed. Internal fixation in severe carpal injuries is advised.     

False aneurysm of the profunda femoris artery following internal fixation of an intertrochanteric femoral fracture

A case is presented of traumatic aneurysm of the profunda femoris artery following spontaneous unscrewing of the nut at the nail--plate junction of a two-piece nail plate which was used for internal fixation of an intertrochanteric femoral fracture. Methods of avoiding this complication during hip operations are described, together with a short review of the literature.     

Symptomatic Status and Pattern of Employment During a Five-Year Period Following Myocardial Revascularization for Angina

The employment status of 100 consecutive male patients between the ages of 30 and 60 years (mean, 49.5 years) operated on for angina and followed for a minimum of 5 years was analyzed. There were no early and 4 late deaths. The probability of employment at 1 year was 90%, which was similar to that of a sample from the general population matched for age. This rate, however, showed steady, slow deterioration to 87.6% at 2 years, 82.1% at 3 years, 75.7% at 4 years, and 73.4% at 5 years. Seventeen patients retired over the 5-year period. There was no correlation between the rate of employment and age (under or over 50) at operation, previous myocardial infarction, or number of grafts inserted.     

The pedestrian problem: a 12-month review of pedestrian accidents

Three hundred and sixty-one pedestrians involved in road accidents in the course of a year have been studied. Fourteen of the pedestrians died following hospital admission, and analysis of data from Strathclyde Police showed that another 16 pedestrians died at the roadside. Certain characteristics of the whole group are reviewed and a plea is made for more appropriate use of available statistics in the production of practical road safety legislation.     

Full thickness burns from ready-mixed cement

The authors present 16 cases of cement burns admitted to the Nottingham burns unit over an 11-month period. Thirteen required skin grafting and were off work for a considerable period of time. The manufacturers do print warnings on their quotations and their delivery dockets, but the serious nature of some cement burns is not stressed. Some suggestions are made in an effort to prevent these serious injuries.     

Mitral Annuloplasty in Endomyocardial Fibrosis: An Alternative to Valve Replacement

The case of a patient with left ventricular endomyocardial fibrosis (EMF) causing severe mitral regurgitation is presented. Excision of the fibrotic tissue through the left atrium and mitral annuloplasty resulted in symptomatic relief and uncomplicated pregnancy. An X-linked congenital dermatological condition, Bloch-Sulzberger syndrome (incontinentia pigmenti), associated with chronic eosinophilia, was also present. This occurrence with EMF has not previously been reported. Atrioventricular valve reconstruction is a feasible alternative to valve replacement in EMF.