Seat belt injury of the breast—a case report

A case is reported of a breast injury sustained as a result of wearing a seat belt. A possible mechanism for this particular injury is proposed.     

Dislocation of the median nerve and brachial artery in supracondylar fractures of the humerus

Two patients are described in whom the median nerve was dislocated and incarcerated between the fragments of a supracondylar fracture of the humerus. In one, the brachial artery was similarly incarcerated and was in spasm. In the second, the brachial artery had been ruptured by the upper fragment. Circulation was restored by operation in both instances. The mechanism of dislocation is discussed.     

An improved traction system for fragile bones

The problems of transcutaneous tibial pins for skeletal traction in elderly patients are considered, and the reasons behind loosening of the pin are discussed. A novel method of skeletal traction using two pins is proposed.     

Combined brachial plexus and spinal cord trauma

The clinical features of combined injuries of the brachial plexus and spinal cord in 31 patients are described. Diagnosis of the brachial plexus lesion was delayed in 17 instances, and the reasons for this are discussed. Early diagnosis is important so that definitive treatment and long-term plans can be instituted without delay. This dual lesion constitutes a very severe disability; as a direct result of their brachial plexus paralysis, 9 paraplegics did not achieve their predicted level of independence. Possible mechanisms of injury are suggested. Motorcycle accidents are particularly likely to cause these injuries, and a plea is made for further legislation to reduce the risks of injuries to young motorcyclists.     

Experience with the use of a Vitrathene brace in the treatment of femoral shaft fractures

Sixty consecutive unselected fractures of the femoral shaft have been treated in a Vitrathene brace lined with Plastazote. All fractures were united at an average of 16 weeks with little shortening. The patients were in hospital for an average of 8 weeks and obtained an average of 115 ° of knee flexion at 6 months after the original injury. To avoid angulation in fractures of the middle and upper thirds of the shaft a pelvic band with the hinge in abduction is necessary.Four other patients referred for treatment, who had delayed union of their fractures, were braced for between 5 and 12 months and all united.The method appears successful and merits further trial.Weight-bearing characteristics of the brace were studied and it was found that 20 per cent of the axial force passed through the brace and 80 per cent through the soft tissues and fracture site.     

Severe injuries of the radial nerve treated by sural nerve grafting

We present six cases of severe injuries of the radial nerve in the arm. These were all treated by autogenous nerve grafting over distances of between 7 and 14 cm up to 26 months after the injury. We describe our results and discuss the place of nerve grafting in the management of these injuries.     

The mechanics of skull traction calipers

The relationship between the torque applied to the loading screw and the load required to pull off Cone's type of skull traction caliper was established on cadavers. It was found that at a torque of 0.7 Newton metres (Nm), which corresponds to a compressive force of 13 lb (58 N) on the skull, the caliper became detached at the maximum traction load of 60 lb, but still held during this traction load at compressive forces above 18 lb (80 N). Clinically, an instrumented load cell was incorporated into one of the fixing pins on a skull traction caliper and it was found that the compressive load fell on average by 15 per cent over a period of 21 days of traction. Taking into account this fall in load with time and the limiting torque for pull-out with a traction force of 60 lb (265 N) it is suggested, for complete clinical safety, that a compressive load of 20 lb (88 N) obtained at a torque of 0.85 Nm should be applied to the loading screw of a Cone's type of caliper. Using these values in a loading analysis of the securing pins, suggestions are made as to the ideal design of skull traction calipers and the shortcomings of various designs of existing calipers are discussed, in particular the pins' lengths, compressive load and the pins' placement.     

An analysis of burns in children

This paper presents an analysis of 146 cases of burns in children of up to 10 years of age admitted and treated in the Mclndoe Research Burns Centre during the period 1971–1975 inclusive. The information needed was obtained from the routinely kept patients' notes. Some epidemiological observations, the general management of the patients and the social aspects of burn injury are presented and discussed.     

Skull traction and its complications

The complications of skull traction seen in a Spinal Injuries Unit over a 7-year period are reviewed. The application of skull calipers, generally thought to be a minor procedure in the initial treatment of cervical spine injuries, led to complications in 37.3 per cent of patients. The complication rate was lowest using the Cone caliper, which when inserted as described, had a complication rate of 6.25 per cent. Attention to detail in the application of skull calipers is essential, and the procedure must not be considered trivial. The Cone caliper is recommended for the initial treatment of traumatic tetraplegia.     

Kinematics in the diagnosis of meniscal lesions

We have studied the findings at operation of 336 knees with a preoperative diagnosis of a meniscus lesion.In 146 knees operated on by three surgeons, after a detailed history and clinical assessment, the findings confirmed the preoperative diagnosis in 116 knees (79.5 per cent). In 47 knees operated on after double contrast arthrography, the diagnosis was confirmed in 43 knees (91.5 per cent). In 50 knees operated on after a study of the instant centre of pathway, the diagnosis was confirmed in 45 knees (90 per cent).We found an improvement of preoperative diagnosis of up to 95.5 per cent when the combination of instant centre of pathway and arthrography were positive in 89 out of 93 knees.     

Orthopaedic traction device--an analysis of forces

By using hanging weights as loads in traction treatment, one has to consider the transient forces created in the traction cord when the weights are displaced. These forces are transmitted to the patient who experiences them, at least in some circumstances, as pain or discomfort. In this paper we describe experiments by which these forces are measured. The traditional traction device, using hanging weights, is compared with two other devices. The study shows that by using these new traction devices--one with a clock spring, the other with a vacuum cylinder--as load generators, the transient forces are reduced to a great extent.     

‘Locking knee’ due to osteochondroma

An unusual cause of locking of the knee is reported, due to an osteochondroma at or around the inner part of the upper tibia. It usually presents in young teenagers who frequently have difficulty extending the knee from a fully flexed position. The cause is interference with the free excursion of the pes anserinus. Excision of a symptomatic osteochondroma has been shown to relieve the complaint.     

The mortality of patients with minor fractures of the pelvis

This simple study was undertaken because clinical audit revealed that several patients died from sudden massive pulmonary embolism following minor fractures of the pelvis. It is well known that pulmonary embolisms may complicate a major fracture of the pelvis, but so far no study has looked at the incidence of fatal pulmonary embolism after minor fractures. This survey, therefore, is a retrospective survey of 50 consecutive patients with a minor fracture of the pelvis, of whom seven died. In five patients the cause of death was a massive pulmonary embolus, and this occurred despite the fact that all patients were up and about as soon as pain permitted.     

Unstable dorsal fractrue-dislocation of the fifth carpometacarpal jont

Four cases of unstable fracture-dislocation of the fifth carpometacarpal joint are reproted, including 3 isolated dorsal fracture-dislocation and 1 dorsal fracture-dislocation associated with a fracture of the fourth metacarpal bone. All cases required open reduction and Kirschner wire fixation which resulted in good function. Attention is drawn to the frequent delay in diagnosis. The applied anatomy is discussed.     

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.     

Ultrasonic assessment of fractures and its use in the diagnosis of the suspected scaphoid fracture

Ultrasound in the therapeutic range was found to produce pain or severe tingling when applied to 80 of 87 fractures of all types less than 2 weeks old. It appears that as the fracture unites the painful response subsides. It was a valuable supplementary test in the wrist suspected of having a scaphoid fracture when a positive result commonly indicated either fracture or a severe soft tissue injury.     

Impalement injury by a tree branch from rectum to right nipple

A case of severe impalement injury in a 26-year-old woman is reported. The patient's survival is attributed in part to the remarkable fact that, despite the track of the impaling object extending from anus to anterior chest wall, no irreparable damage was done. Important points in the management of this injury are described.     

A skeletal traction stirrup with self-aligning low friction joints to reduce pin loosening

Skeletal traction may be complicated by loosening of the pin transfixing the bone, especially if the bone is osteoporotic. A loose pin predisposes to infection of the pin track.A skeletal traction stirrup with self-aligning low friction joints has been developed to reduce the incidence of pin loosening.