Traumatic rupture of the thoracic aorta-a radiological pitfall.

A previously undescribed feature of a traumatic thoracic aneurysm is presented. The pateint was a young motor cyclist who sustained multiple injuries and died 10 days after admission from delayed rupture of the thoracic aorta which had dissected along oesophageal planes into the stomach. Although the radiological features of traumatic mediastinal haematoma were evident shortly after injury, these features had disappeared in later radiographs creating a false sense of security.     

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.     

Severe injuries of the upper end of the humerus

A retrospective survey of 32 comminuted fractures of the humeral head and fracture-dislocations of the shoulder treated by a variety of methods except for replacement arthroplasty showed that the majority regained a functional range of shoulder movement whatever the radiological appearances. The older patients were more satisfied with the result than the younger.     

Pneumopericardium following closed chest injury: a report of two cases

Two cases of pneumopericardium complicating closed chest injury are reported. The first of these was complicated by aortic rupture and made a good recovery. We have been unable to find this combination of injuries previously documented in the literature. The second case was discovered at post-mortem examination.     

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.     

Dislocations of the ankle without fracture

Five cases of dislocation of the ankle without fracture are described, and the literature is reviewed.     

Traumatic pneumoerricardium

A case is described in which pneumopericardium occurred with a stab wound of the left chest, accompanied by systolic crackling and board-like abdominal rigidity.     

Fungal infection in burn patients: Results of using 5-fluorocytosine (flucytosine)

Fungal infection and use of 5-fluorocytosine were studied prospectively among burn patients receiving multiple antibiotics. From 22 out of 23 patients positive cultures for Candida were obtained. Cultures from the mouth and rectum became positive first. Averaging 6 days later, 16 patients had positive urine cultures. Candida in urine was the best way to detect systemic candidiasis.Nine patients received 5-fluorocytosine. Although this drug did not influence survival among patients with burns of less than 59 per cent of body surface area, it prevented death from disseminated Candida infection among patients with burns of greater than 60 per cent body surface area.Patients with large surface burns receiving multiple antibiotics should have prophylaxis against fungi. If Candida is detected in urine, systemic treatment should be given. 5-Fluorocytosine is a safe and effective systemic drug for this purpose.     

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.     

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.