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.     

Fracture due to shock from domestic electricity supply

This report describes a fracture-dislocation of the shoulder joint due to electric shock. This is the first case reported in an English language journal of fracture due to shock from the domestic electricity supply. Other cases have been reported but not caused by such a low voltage current.     

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.     

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.     

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.     

Late results after vertical fracture of the talus

Twenty-seven patients were examined on an average of 5 years after sustaining a vertical fracture of the talus. One patient had bilateral fractures. In spite of degenerative osteoarthrosis being visible on the radiographs, the functional results were good. Necrosis of the talus with deformity was consistent with surprisingly good function of the foot, subjectively and objectively. Operative reduction of the fracture had a high frequency of complications. The indications for primary talectomy in a fracture of this bone, as advocated by some other authors, is discussed. Closed reduction should be tried before open reduction is performed. If operation is necessary, the soft tissues must be treated with the utmost care in order to avoid necrosis and infection.     

Manganese absorption through a burn

A case of manganese absorption occurring in association with a burn is presented. We maintain that acute manganese toxicity was a likely cause of liver dysfunction in our patient.     

Evidence for the local denaturation of collagen fibrils during the mechanical rupture of human tendons

The ends of ruptured human tendons have been examined by scanning electron microscopy. The collagen fibres taper markedly, often leading up to a coiled segment or a knot of collagen at the point of rupture. This tapering of the collagen fibres was shown to be typical of denatured collagen by its selective removal by trypsin digestion. This denaturation caused by mechanical rupture was shown to be localized at the point of rupture, the rest of the collagen fibre remaining in the native state. The possible significance of these observations to the healing of ruptured tendons is discussed.     

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.     

Multiple intramedullary nailing of pertrochanteric fractures with elastic nails: operative procedure and results

Two hundred and sixty-six pertrochanteric fractures were operated on using intramedullary fixation according to the method of Ender and Simon-Weidner. Evaluation of both early and late results prove it to be a method with a low complication rate and a high incidence of functional recovery.     

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.     

Self-inflicted burns

A 2-year study of self-inflicted burns admitted to seven burns units showed that deliberate self injury by burning might be uncommon, but not rare. Contrary to the popular assumptions behind such acts being political/religious, the study showed that they were often for social and personal reasons. The outcome of burn injuries can be fatal, the study suggests that both physical and psychiatric treatment for such patients must proceed simultaneously from the onset. Also more research is needed.     

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.     

Early intramedullary nailing of femoral shaft fractures: A cause of fat embolism syndrome

Results of our retrospective review of 100 consecutive patients show that early intramedullary nailing can be accomplished in severely injured patients without increasing the risk of fat embolism syndrome. No cases of fat embolism syndrome were seen after immediate (less than 24 hours) intramedullary nailing of femoral shaft fractures. In contrast, five cases of fat embolism syndrome were found in the patients treated in the traditional manner with initial balanced skeletal traction and delayed intramedullary nailing. There was a trend toward more pulmonary complications in the immediate group. This is attributed to the greater severity of injury present in the patients selected for immediate intramedullary nailing (injury severity scores 23.2 in immediate group; 12.4 in delayed group). The incidence of critical hypoxemia in the immediate group was equivalent to that in another group of injured patients who did not have fractures, but who did have similar injury severity scores.     

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.     

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.     

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.     

Instances in which intramedullary nailing of a child's fracture is justifiable.

Two cases of fractures of the femur in childhood where internal fixation was indicated are described. Internal fixation of children's fractures is rarely justifiable (Blount, 1955), partly because of the rarity of non-union and partly because moulding usually corrects what may at first have been unacceptable deformity. Among the methods of internal fixation, Küntscher nailing for fracture of the shaft of a child's femur may seem to be the most difficult to defend. Nevertheless, there are occasions when it becomes necessary, although it might have been possible to avoid the operation by better care at the time.     

The possible value of arteriography supplemented by a vasodilator agent in the early assessment of tissue viability in frostbite

Two cases of frostbite were examined by arteriography shortly after admission to hospital and again several days later. The arterial circulation at the first examination was in both cases reduced, but showed a marked improvement later. These findings suggest that there may be, perhaps to a greater degree than has been assumed before, transient damage to the larger vessels immediately proximal to the frostbitten areas.The vasodilator bradykinin had initially no effect on the vessels of the case with severe frostbite but caused vasodilatation of the vessels in the less severely injured case.The well-known expression ‘frozen in January, amputate in July’ epitomizes the difficulties in deciding the amputation level from clinical signs and symptoms alone. Repeated arteriograms in the period after injury may assist the surgeon in his management of frostbite. If arteriograms supplemented by a vasodilator agent made one month after injury do not show any vessels in the distal part of an extremity, revival of these tissues can hardly be expected.