The use of seat belts by motor car occupants involved in road traffic accidents

Two hundred and forty-four motor car occupants involved in road traffic accidents, who sustained injuries sufficiently severe to require admission to hospital, have been investigated in order to assess the value of seat belts. The results indicated that the use of seat belts significantly reduced the mortality and the number of severe, multiple and facial injuries.     

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.     

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.     

Patterns in traumatic rupture of the bronchus

Some ruptures of the bronchus are diagnosed early but in many there is a long delay. This is because there are two distinct clinical patterns, one of which is not well recognized.In the first there is free communication between the bronchus and the pleura and the diagnosis is easily suspected when the lung fails to re-expand with adequate pleural suction.In the second there is little or no communication between the rupture site and the pleura. The peribronchial tissues maintain a conduit and ventilation of the lung continues until obstruction is produced by granulation tissue after a week or more. The lung then becomes airless and a mistaken diagnosis of retained secretions is easily made.The two types are illustrated by case reports.     

An approach to the treatment of hand burns

Burns of the dorsum of the hand may occur in isolation or as part of a more extensive burn. In planning treatment we are guided by the general condition of the patient as well as the local condition of the hand. The depth of these burns is often in doubt and a conservative policy is often indicated.

If infection is avoided many deep burns heal spontaneously. Intensive physiotherapy from the outset reduces oedema and rapidly restores mobility. A Bunyan bag technique using sulphamylon as the antibacterial agent has minimized infection and allowed free movement of the hands.

Using this method the large majority of dorsal burns of the hands heal in 4–5 weeks and show almost normal mobility.     

Fractures of the calcaneum: a study of the long-term prognosis

Two hundred and three consecutive fractures of the calcaneum occurring in 185 patients between 1961 and 1968 have been reviewed. These patients were treated by essentially non-operative methods. The study revealed that fracture of the calcaneum is a relatively common injury, after which persisting symptoms are frequent. Symptoms present two years after injury showed little tendency to improve. The duration of absence from work was often lengthy. The prognosis after this fracture is better if the fracture does not involve the posterior talocalcaneal joint. The usual radiographs taken to investigate a suspected calcaneal fracture seldom provide adequate information about the congruity of that joint, and oblique views are recommended.The results of non-operative treatment, though no worse than reported results of operative intervention, are not good enough and demand further studies on this subject.     

Injury and pregnancy

This subject receives very little attention in textbooks and most of the articles in journals report small numbers of injuries of one kind or another. One general review suggests that between 5 and 10 per cent of pregnant women suffer injury, usually with no risk to the pregnancy: for example, the incidence of abortion ascribed to accidental injury is less than 1 in 10,000. Personal and reported experience can be summarized as follows. The baby may be injured during pregnancy or during birth, or may be harmed by the effects or complications of injury to the mother, e.g. Gram-negative septicaemia or hypoxic states. Injuries inflicted on the baby during pregnancy are most often fractures, which affect the skull almost as often as any other bone, and frequently accompany fractures of the mother's pelvis. Gunshot and other penetrating injuries of the child are rare and are not always fatal. Fractures of the maternal pelvis are the most frequent of the major injuries and are serious to viscera and other parts of the body. In some patients deformation of the pelvis can be corrected or prevented by operation, but it is usually best accepted. Rigid internal fixation of fractures of the lower limbs sustained in the later months of pregnancy can make labour much easier for the patient and her attendants. If the effect of injury on pregnancy is usually obvious, the effect of pregnancy on recovery from injury is usually not.     

Injury of the acetabular epiphysis

A patient with injury of the acetabular epiphysis is presented. Following trauma to the acetabulum a bone bridge forms across the epiphysis, leading to distortion of the acetabulum.     

Experience in the accident and emergency department of the Royal Victoria Hospital with patients from civil disturbances in Belfast 1969-1972, with a review of disasters in the United Kingdom 1951-1971

Within a period of 3 years the Royal Victoria Hospital, Belfast, had to use its disaster drill on 46 occasions. On attempting to find the number of disasters in the United Kingdom since the setting up of the National Health Service, records of 42 other disasters were found. Reports of these disasters were studied, the literature in British medical journals was read, and this with personal experience in the Royal Victoria Hospital is the basis of a discussion on disaster planning. Some recommendations are made.     

First-line medical care for the injured

The development of a joint hospital and general practitioner organization in East Cumberland to provide medical aid for the seriously injured before they reach hospital is described. The advantages of such a joint organization are presented.     

Severe irreducible slipping of upper femoral epiphysis: a review of 14 cases treated by subtrochanteric osteotomy

Children with signs of slipping of the upper femoral epiphysis often present in an Accident Service, particularly after a severe, acute slip. In some cases the displacement is irreducible and correction of the persistent deformity by either cervical or trochanteric osteotomy is required. This paper is a review of 14 cases of irreducible slipped upper femoral epiphysis treated by subtrochanteric osteotomy. Clinical and radiological assessment of these cases some years later shows a high proportion of successful results and suggests that this is a safe and satisfactory method of treating this condition.     

Self-inflicted rotation osteotomy of the tibia

A case is described in which two accidental injuries were instrumental in correcting bilateral club feet. The role of rotation osteotomy in the correction of deformity of the foot is discussed.     

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.     

The causes of injuries requiring admission to hospital in the 1970s

One thousand four hundred and seventeen patients admitted to hospital as a result of injury have been investigated as to the aetiology of the injury. The commonest cause of injury was road traffic accidents but there were many other causes including domestic accidents, sport, alcohol, assault, and injuries sustained at work and in the street. Many of these accidents were avoidable and it is suggested that large publicity campaigns to make people aware of the possible hazards they face in their home, at work, on the playground and on the street might be indicated.     

An unusual penetrating injury of the cheek: a case report

The immediate management of an unusual penetrating injury of the cheek is described. The early problems that arose following operation and their management are discussed. There is very little residual disturbance of function and surgical revision of the facial scars is being deferred for the time being.     

The syndrome of the fracture of the lesser trochanter in adults: a neglected aspect of the trochanteric fracture

The effects of associated fractures of the lesser trochanter were observed in 18 (47.4 per cent) out of 38 patients with trochanteric and subtrochanteric fractures when the lesser trochanter was grossly displaced. This syndrome, comprising mechanical, reflex, post-traumatic, and late features, is a reliable guide to the prognosis of these elderly patients.     

Disruption of symphysis pubis while horse riding: a report of two cases

Two unusual cases of disruption of the symphysis pubis as a result of horse riding accidents are reported. Both were treated satisfactorily by support in a pelvic sling.     

Missed fractures

Review of the radiographs of 160 patients admitted to hospital as a result of injury revealed that 12 (7.5 per cent) had fractures which were missed on admission and subsequently detected.

The significance of this finding is discussed and the need for thorough and repeated examination of the injured patient re-emphasized.     

Supracondylar fractures of the humerus in children with a note on the surgical correction of late cubitus varus

A new classification of supracondylar fractures is proposed in the light of experience gained in treating a large series of these fractures in children. This classification has proved useful as a guide to the clinical management of these injuries and helpful in predicting the likelihood of complications both early and late.     

Visits abroad: the treatment of pseudarthrosis in the Soviet Union

Three British surgeons on a visit to Russia were impressed with the Russian technique known as ‘compression distraction’ used mainly in the treatment of infected pseudarthrosis of the tibia. Multiple thick Kirschner wires drilled through the tibia at a distance from the lesion were fixed in stirrups attached to steel rods and turnbuckles. By adjustment of the apparatus deformity was corrected at the time of application; shortening was overcome by gradual turnbuckling. The equipment was also used for leg lengthening and for complicated recent injuries.