Isolated jejunal injuries arising from blunt abdominal trauma

Examples of isolated jejunal injuries due to blunt abdominal trauma are presented. The mechanisms of injury and management are discussed, together with a brief review of the literature.     

A complication of intramedullary nailing

A case is described of intramedullary nailing of the femur, complicated by non-union, fracture of the nail, pseudarthrosis, malunion and subsequent distal migration of the proximal nail fragment over a period of 8 years.     

Arterial injury associated with skeletal trauma

A review of 40 cases with combined skeletal and arterial injury. The diagnosis and management of this combination of injuries is discussed, with emphasis on the relative merits of external immobilization as opposed to internal fixation of the fracture. One quarter of these cases eventually came to amputation, and the reason for failure is explored in detail.     

Intramedullary nailing for fractures of the femoral shaft

The results of a survey of 136 fractured femoral shafts treated by open reduction and intramedullary nailing between 1963 and 1970 are presented.Complications of the operation such as mechanical failure of fixation, wound infection, delayed union and non-union are discussed.The final results based on the range of knee flexion and freedom from complications are given: 80 per cent of the results were good.     

The knee after midshaft femoral fracture treatment: a comparison of three methods

A retrospective study of knee function has been carried out in 85 patients who had fractures of the midshaft of the femur treated by three currently used methods. Patients who had undergone open medullary fixation, skeletal traction with early knee movements, and skeletal traction with an immobile knee have been compared. All the patients were reviewed personally, with a mean follow-up time of 5 years. We found that 30 per cent of all the patients had minor knee symptoms, and nearly half (45 per cent) had some ligamentous laxity. When bony union resulted, there was no difference in the effect on knee function between the three methods of treatment. Neither skeletal traction nor early knee movement had a harmful effect on the knee in the absence of any major ligamentous injury.     

Pretibial flab wounds: early grafting under regional anaesthesia as an outpatient procedure

A method is described of treating thin flap wounds of the leg which involves primary excision followed by delayed primary closure by skin graft carried out under regional nerve block. This method avoids not only admission to hospital but the hazards of general anaesthesia in patients who are often elderly, or taking steroid drugs. In 38 out of 40 patients so treated, the grafted area was sufficiently well healed to require either no dressing or a protective dressing only after 2–3 outpatient visits spread over 15–16 days.     

Trauma and the cystic meniscus: Review of 500 cases

A review is presented of 500 cases of cystic menisci diagnosed clinically. The distribution by age, sex, side, and site is analysed as is the mode of presentation, history, and type of trauma, as well as locking.

Operative findings in 299 patients are discussed, undamaged menisci being found in 50 per cent.

With a history of trauma (37 per cent) the meniscus was found to be damaged in 59 per cent, without it the incidence was 45 per cent.     

Catecholamine excretion in burns in children

The excretion pattern of adrenaline and noradrenaline in children with burns has been studied and compared with that of a number of controls of similar age. Very high outputs of both catecholamines were found in the more extensively burned children, and the output of adrenaline increased relatively more than did that of noradrenaline, though the output of noradrenaline was always quantitatively greater.

The relatively high output of adrenaline may be related to the environmental temperature in which the children were nursed. The evidence for and possible causes of partial failure of adrenaline production in burns are also discussed.     

The long-term effect on the tibiofemoral compartment of the knee joint of comminuted fractures of the patella

We have studied the long-term effect of comminuted fractures of the patella with particular reference to the development of degenerative changes in the tibiofemoral joint. Degenerative changes which could convincingly be ascribed to the original injury were found in only one case, but we stress that the numbers are small, and that careful search should be made at operation for damage to the femoral condyles.     

Early mobilization in the treatment of shin injuries.

The treatment of shin injuries requiring skin grafting by a method which included early mobilization is described.     

The place and efficacy of operative management of fractured clavicle

A study of 22 cases of operative fixation of the fractured clavicle has been made. This has shown that with internal fixation and onlay bone grafting, highly successful results can be attained. There were no cases of non-union and there have been no significant complications. The indications for such surgery are presented from the literature. It is clear that the operation is not commonly indicated, but when performed is safe and highly successful.     

A case of Pseudomonas aeruginosa osteomyelitis of the tarsal cuboid following a penetrating wound of the foot in childhood

A case of Pseudomonas aeruginosa osteomyelitis of the cuboid following a penetrating wound of the foot is presented. The clinical course is described and the subject of plantar puncture wounds leading to bone infection is discussed.     

Self-inflicted nail-gun injury of the heart and lung: a short report

A 26-year-old man attempted suicide by shooting himself with a nail-gun that he was using at work. The nail passed through the left ventricle of the heart and both lobes of the left lung without producing major haemorrhage or tamponade. Following operation he made a good recovery.     

Late obstructive jaundice due to traumatic pancreatic granuloma

A woman sustained a ruptured liver in a road traffic accident. After a stormy postoperative course she recovered. One year later, obstructive jaundice developed and the patient underwent a pancreatico-duodenectomy with complete recovery. The cause of the biliary obstruction was a granulomatous lesion in the head of the pancreas which had formed as a result of injury to the bile duct at the time of the road accident.     

Bullworker's fracture

Three cases of humeral shaft fracture sustained by healthy athletic young men when exercising with a Bullworker compression apparatus are described (Fig. 1). No previous cases have been reported. The mechanism of the injury is discussed.     

Multiple fractures of the pelvis with an unusually wide disruption of the symphysis pubis sustained in an accident shortly after childbirth: a case report,

A case of multiple fractures of the pelvis with wide separation of the pubic bones associated with other extensive injuries is reported. The diastasis of the symphysis pubis was reduced with surprising ease at operation. A pink discharge from the vagina was seen at the operation, but its significance was only clear after 3 days when the patient revealed that she had given birth to a child on the day before the accident. The soft relaxed pelvic and sacro-iliac ligaments associated with pregnancy prevented damage to the sacro-iliac joints and made it easy to reduce the disrupted symphysis.     

Olecranon fractures in children.

A series of 40 cases of fractures of the olecranon in children under the age of 11 years is presented. These fractures are commonest at 5 years of age and are almost twice as common in boys as in girls. The fracture is usually undisplaced and incomplete; fractures in the long axis of the ulna (the 'longitudinal split' fracture) are not uncommon in children. Associated injury of the proximal end of the radius is recognized. Only 2 cases were sufficiently displaced to require open reduction. Although immobilization in plaster with the elbow at 90 degree for a month is usually recommended, the results indicate that in the usual undisplaced and incomplete fracture, a period of 3 weeks in a sling may be all the treatment necessary.     

Local anaesthesia in the reduction of Colles'' fracture

Local infiltration anaesthesia for the reduction of Colles' fracture is effective, easily performed, free from side effects, and well received by the patient. This opinion is based on a series of 280 cases treated in the casualty departments of two Bristol hospitals.     

Lumbosacral fracture-dislocation: a case managed conservatively, with return to heavy work

A 41-year-old agricultural sustained a lumbosacral fracture-dislocation when a tree fell across his back. The initial anterior displacement of half the depth of the body of L5 progressed to three-quarters of the body over a 2-year period. Neurological deficit was minimal and the management was conservative. Spontaneous arrest of the displacement occurred by anterior sacral buttressing and the patient has returned to his previous heavy work.     

A new guard for Kirschner wires

Means of providing adequate protective cover for Kirschner wires protruding through the skin were investigated. A new guard was developed which satisfactorily abolishes the difficulties associated with other forms of cover.