Displaced radial neck fractures in children

Forty-eight children with displaced fractures of the radial neck were studied. Five types of injury were seen, that associated with a valgus strain being the most common. Good results were obtained in just over one-half of the cases. It is concluded that treatment of these fractures should be by closed means whenever possible. It is generally unwise to attempt operative correction unless the radial head remains displaced or the residual angulation approaches 45 degrees. Open reduction should be checked by intraoperative radiographs. Internal fixation is seldom necessary and has its complications. Late manipulation of the fracture causes additonal trauma and the results are bad. Avascular necrosis and radio-ulnar synostosis were the two most disabling complication encountered.     

The use of Kiton Fast Green to measure the viability of the head of the femur after fractures of the neck of the femur

An intravital staining method was used to predict the viability of the femoral head at operation in 36 patients with fractures of the neck of the femur. Life was predicted in 18 heads, death in 16 and in 2 there was some doubt.In the group which was predicted to be live, 15 fractures united uneventfully, 1 developed late collapse and 2 became infected and died. Of the heads predicted to be dead, 3 united without evidence of necrosis, four had radiological changes suggesting that necrosis had been followed by revascularization and 10 required further operations. Histological evidence was later obtained in 19 cases. Of 6 heads predicted to be live, 4 had united without evidence of necrosis, 1 showed necrosis and collapse and 1 was infected and dead. Of the heads predicted to be dead, 8 were dead, 4 showed revascularization taking place and 1 showed no evidence of bone necrosis. Intravital staining is a relatively easy technique but has limitations as a means of predicting the clinical outcome.     

Proximal forearm fractures in children: residual disability

Fifty-one children with upper forearm fractures showing early malunion or functional loss have been reexamined. Three children had marked loss of function.A case is made for internal fixation in those rare instances in which total displacement occurs with shortening, whether primarily or after refracture.     

Two cases of non-union of carpal scaphoid fractures in children

Two cases of non-union of fractures of the carpal scaphoid in children are described, which were successfully treated by cancellous bone grafting with Kirschner wire fixation.     

Fatal complications of the surgical treatment of distal fractures of the femur

Two deaths following the insertion of a Küntscher nail and cement fixation of distal femoral fractures of the femur are described and the possible aetiology is discussed.     

Bilateral fractures of the femoral neck

This study has analysed 500 patients admitted with fractures of the femoral neck. Fifty-three (10.6 per cent) had previously fractured the opposite hip. Thirty-eight per cent had fractured the second side within 1 year of the original fracture, and 74 per cent had initially sustained an intracapsular lesion. Eighty-three per cent sustained a similar type of fracture on both sides. The 3-month mortality following a second fracture was 30 per cent compared with 13 per cent following a first fracture.Thus, following a single fracture there is a significant risk of a second fracture, with an associated high mortality rate. This problem will only be solved if effective, prophylactic measures can be found to prevent bone mineral loss.     

Fractures of the olecranon in children

Forty-nine fractures of the olecranon in children have been followed for up to 3 years after the injury. A notably large number (22) sustained associated injuries or complications which delayed or prevented a satisfactory outcome. Just over half of the whole series (27) achieved a satisfactory return to normal use within 12 weeks. Methods of treatment and a number of important complications are discussed.     

The management of fractures in Paget''s disease of bone

The results of the treatment of 89 fractures of bone affected by Paget's disease are presented. The typical features of these fractures, the common sites affected, the rate of healing and the complications involved, including the incidence of malignant change, are reviewed. The possible role of calcitonin in the prevention of these fractures is discussed.     

Penetration in trochanteric fractures of the femur treated with rigid nail plates

One hundred and twelve trochanteric fractures have been analysed. A Jewett nail-plate was used in 81 patients and a Thornton nail-McLaughlin plate in 31.Penetration of the nail into or through the hip joint was the only complication studied in detail. It occurred in 41 cases: 31 (38 per cent) with the Jewett nails and 10 (33 per cent) in the other group.Both groups are comparable in that the nail-plate acts as a single rigid unit and the nail/plate angle varied, but the overall incidence of migration of the nail was similar. All the 112 cases were reviewed as one group.Penetration was more common in comminuted unstable types of fracture, in those poorly fixed, and in the older patients.Sixteen (14 per cent) well-fixed fractures showed penetration. It appears that one important additional reason for penetration in this series was the rigidity of the device and the poor quality of the bone.The incidence of nail penetration in comminuted unstable fractures of the femur might be reduced by using methods of fixation other than rigid nail-plates.     

Bilateral posterior dislocation of the shoulder

The purpose of this article is to present two cases of bilateral posterior dislocation of the shoulder. A review of the previously reported cases reveals the rarity of this injury, its association with seizures and the frequency with which it is misdiagnosed.     

Lower limb injuries in motorcycle accidents

A four month study was conducted at Southampton General Hospital of the injuries sustained by motorcycle riders, 104 of whom (60%) returned a postal questionnaire about the accident, rider and motorcycle. The study confirmed that injuries to the lower limbs are a major cause of morbidity and the long time spent in hospital. Further investigation identified specially vulnerable areas. In particular, for 'severe' lower limb injuries, the 'shin' region was identified as the most vulnerable area, and the force producing the injury was generally applied to the other side of the other side of the limb by another vehicle. 'Crash bars' were found to be ineffective in reducing either the incidence or severity of lower limb injury.     

Internal fixation of fractures of the neck of the femur in hemiplegic patients

There was a history of hemiplegia due to stroke in 97 (6.5 per cent) of 1483 consecutive patients with fresh fractures of the neck of the femur. Both cervical and trochanteric fractures occurred significantly more often on the hemiplegic side. Internal fixation was technically satisfactory in trochanteric fractures, but failed frequently in cervical fractures.     

Primary total hip replacement for displaced subcapital femoral fractures

A retrospective survey of 48 patients, in whom total hip arthroplasty was undertaken as the primary management of displaced subcapital femoral fracture, has established that results are sufficiently good to merit a prospective trial of total arthroplasty against hemi-arthroplasty for this condition. Prosthetic dislocation occurred in 7 patients and was the major complication, but successful results were not thereby precluded.     

Early weight bearing in tibial shaft fractures protected with wooden splints

Evaluation of the rate of union of 40 adult tibial shaft fractures treated in below-knee wooden splints together with early weight bearing showed that fractures healed faster and patients returned to normal activity earlier than patients who were allowed early weight bearing in above-knee casts. Shortening was not increased.     

Subtrochanteric fractures of the femur through the track of the lower Garden screw--treatment with a Richards sliding screw

Four cases of subcapital femoral fractures, initially treated by internal fixation with Garden screws and subsequently complicated by subtrochanteric fractures through the lower screw hole, have been successfully treated by substitution of a Richards sliding screw of corresponding angle for the lower screw. All 4 subtrochanteric fractures united without implant failure. One subcapital fracture failed to unite and secondary femoral head replacement was unimpeded.     

Fractures of the femoral neck in the ‘young’ elderly

Eighty-six patients, aged under 60 years, who had sustained fractures of the femoral neck, were studied, as well as the circumstances of injury and the long term medication they may have had. They were divided into two groups: ‘injured’ (38), with an average age of 41 years, and the ‘uninjured’ (48), with an average age of 55 years. Unlike other series, the male to female ratio was equal.Trochanteric fractures were more common in men involved in high speed accidents and the prognosis was excellent, but subcapital fractures were most frequent in patients with concurrent illness and 77 per cent were taking drugs which could affect bone density. The prognosis in these relatively young patients with subcapital fractures was no different from that in much older patients: 28.5 per cent developed avascular necrosis and 21.4 per cent required prosthetic replacement.     

Simple external fixation of open and complicated fractures

Thirty patients were managed with the use of a simple means of external fixation. Ten of these patients had multiple injuries. In 18 the fractures were open. Five cases had loss of bone length and infected wounds when first seen and were treated with the aid of microvascular surgical procedures. Eight cases required skin grafting. One case required a vein graft to the popliteal artery. The method described is simple to use. It requires little previous experience and is cost effective. We recommend its use in the initial treatment of grade 2 and 3 open fractures. It may also be used on closed unstable fractures, and will maintain limb length in severe injuries with loss of bone substance while further treatment is considered or performed.     

A free bone block operation for recurrent anterior dislocation of the shoulder joint

An operation to prevent recurrent anterior dislocation of the shoulder by insertion of a free iliac bone graft into an anterior glenoid osteotomy is described and has been performed on 16 shoulders in 15 patients. No additional fixation of the graft was used and the divided subscapularis tendon was not sutured. The average follow-up was 7 years and 8 months, no serious complications occurred, there were no recurrences, there was no evidence of degenerative osteoarthrosis and only 4 patients had any detectable loss of power. Only 2 patients had noticed any restriction of movement. There was some loss of external rotation in 13 shoulders. All patients returned to their desired levels of work and sporting activity after operation. The operation is technically easy to perform and has comparably excellent results to other published series.