- Email: [email protected]
Contracture of traumatized tissue
318
The series demonstrates ' that adequate wound d6bridement and exploration, application of a total contact long leg plaster and early ambulation with controlled weight-bearing will give excellent results in most cases '. BURKHALTER W. E. and PROTZMAN R. (1975) The tibial shaft fracture. J. Trauma 15, 785.
Femoral shaft fractures There is a review of the cast-brace literature and a report of the results of this treatment in 73 patients with 76 fractures of the femoral shaft. The average age was 34, and 65 of the fractures were closed and 11, open. Forty-five of the fractures were in the middle third, 23 in the lower third and 7 in the upper third. All fractures were treated in a splint with skeletal traction till ' s t i c k y ' (average 4.7 weeks) and then were put into a cast-brace. The average hospital stay was 5.8 weeks and treatment time was 15.3 weeks. In 68 patients the result was satisfactory and in 8, unsatisfactory. Of the unsatisfactory, 3 had realposition with angulation or shortening, and 1 open fracture was infected, with delayed union and bone grafting. The other 4 had less than 90 per cent of knee movement, and of these 2 had soft-tissue injury to the knee and 2 were supracondylar fractures in the elderly. The method is said to facilitate early rehabilitation of the extremity and the patient and to leave minimal residual disability. BROWN P. E. and PRESTONE. T. (1975) Ambulatory treatment of femoral shaft fractures with a cast-brace. J. Trauma 15, 860. Inferior metal for implants causes trouble The slow onset of a low-grade inflammatory reaction, one without infection, the other with, around corroding steel implants is described. Radiographs resemble many that have been published of the corrosion reaction in bone and show also disintegration of the metal. Analysis revealed that the implants were made of a martensitic steel, a type of stainless that was abandoned in the 1930s. On a subject with a bibliography upwards of 20 references a year, the 2 references are a disappointment. A very useful phase diagram for stainless steel is given.
Injury : the British Journal of Accident Surgery Vol. 7/No. 4
PuG~ J., JAFFEW. L. and JAFFEF. (1975) Corrosion failure in stainless-steel implants. Surg. GynecoL Obstet. 141, 199.
Dislocation of the femoral head prosthesis Failure to obtain the necessary degree of anteversion of the head relative to the shaft predisposes to dislocation by rotation of the stern in the femoral shaft. Use of cement helps to stabilize. D'AMBROSIA R. D., CHUINARD R. G., D'AMICO D., SHORTLEY H. F. and BECKERJ. C. (1975) An analysis of dislocation of the cemented femoral hemi-arthroplasty. Surg. Gynecol. Obstet. 141, 534. Vascular injuries Angiography in pelvic trauma Arterial rupture, arteriovenous aneurysm and other complications of severe pelvic trauma can be diagnosed by arteriography or venography or by embolization with autogenous clot. RING E. J. and WALTMANA. C. (1974) Angiography in pelvic trauma. Surg. GynecoL Obstet. 139, 375. Anatomy of arteries in the lower leg In an article dealing with treatment of arterial insufficiency there is a large section on the anatomy of the arteries of the leg and of their variations, which is also of use to the traumatologist. TIEFENBRUNJ., BECKERMANM. and SINGERA. (1975) Surgical anatomy in bypass of the distal part of the lower limb. Surg. Gynecol. Obstet. 141, 528. Contracture of traumatized tissue To the clinician, contracture in some cases seems to be active and malignant, not only resisting attempts at stretching but giving the impression of fighting back in response and contracting more vigorously. Biopsies of contracted interosseous muscles in the hand revealed under the electron microscope the presence of modified fibroblasts with certain features of smooth muscle cells. These resemble myofibroblasts seen in contracting wounds. MADDEN J. W., CARLSONE. C. and HINES J. (1975) Presence of modified fibroblasts in ischaemic contracture of the intrinsic musculature of the hand. Surg. Gynecol. Ob~'tet. 140, 509.
The series demonstrates ' that adequate wound d6bridement and exploration, application of a total contact long leg plaster and early ambulation with controlled weight-bearing will give excellent results in most cases '. BURKHALTER W. E. and PROTZMAN R. (1975) The tibial shaft fracture. J. Trauma 15, 785.
Femoral shaft fractures There is a review of the cast-brace literature and a report of the results of this treatment in 73 patients with 76 fractures of the femoral shaft. The average age was 34, and 65 of the fractures were closed and 11, open. Forty-five of the fractures were in the middle third, 23 in the lower third and 7 in the upper third. All fractures were treated in a splint with skeletal traction till ' s t i c k y ' (average 4.7 weeks) and then were put into a cast-brace. The average hospital stay was 5.8 weeks and treatment time was 15.3 weeks. In 68 patients the result was satisfactory and in 8, unsatisfactory. Of the unsatisfactory, 3 had realposition with angulation or shortening, and 1 open fracture was infected, with delayed union and bone grafting. The other 4 had less than 90 per cent of knee movement, and of these 2 had soft-tissue injury to the knee and 2 were supracondylar fractures in the elderly. The method is said to facilitate early rehabilitation of the extremity and the patient and to leave minimal residual disability. BROWN P. E. and PRESTONE. T. (1975) Ambulatory treatment of femoral shaft fractures with a cast-brace. J. Trauma 15, 860. Inferior metal for implants causes trouble The slow onset of a low-grade inflammatory reaction, one without infection, the other with, around corroding steel implants is described. Radiographs resemble many that have been published of the corrosion reaction in bone and show also disintegration of the metal. Analysis revealed that the implants were made of a martensitic steel, a type of stainless that was abandoned in the 1930s. On a subject with a bibliography upwards of 20 references a year, the 2 references are a disappointment. A very useful phase diagram for stainless steel is given.
Injury : the British Journal of Accident Surgery Vol. 7/No. 4
PuG~ J., JAFFEW. L. and JAFFEF. (1975) Corrosion failure in stainless-steel implants. Surg. GynecoL Obstet. 141, 199.
Dislocation of the femoral head prosthesis Failure to obtain the necessary degree of anteversion of the head relative to the shaft predisposes to dislocation by rotation of the stern in the femoral shaft. Use of cement helps to stabilize. D'AMBROSIA R. D., CHUINARD R. G., D'AMICO D., SHORTLEY H. F. and BECKERJ. C. (1975) An analysis of dislocation of the cemented femoral hemi-arthroplasty. Surg. Gynecol. Obstet. 141, 534. Vascular injuries Angiography in pelvic trauma Arterial rupture, arteriovenous aneurysm and other complications of severe pelvic trauma can be diagnosed by arteriography or venography or by embolization with autogenous clot. RING E. J. and WALTMANA. C. (1974) Angiography in pelvic trauma. Surg. GynecoL Obstet. 139, 375. Anatomy of arteries in the lower leg In an article dealing with treatment of arterial insufficiency there is a large section on the anatomy of the arteries of the leg and of their variations, which is also of use to the traumatologist. TIEFENBRUNJ., BECKERMANM. and SINGERA. (1975) Surgical anatomy in bypass of the distal part of the lower limb. Surg. Gynecol. Obstet. 141, 528. Contracture of traumatized tissue To the clinician, contracture in some cases seems to be active and malignant, not only resisting attempts at stretching but giving the impression of fighting back in response and contracting more vigorously. Biopsies of contracted interosseous muscles in the hand revealed under the electron microscope the presence of modified fibroblasts with certain features of smooth muscle cells. These resemble myofibroblasts seen in contracting wounds. MADDEN J. W., CARLSONE. C. and HINES J. (1975) Presence of modified fibroblasts in ischaemic contracture of the intrinsic musculature of the hand. Surg. Gynecol. Ob~'tet. 140, 509.