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Stress fractures of the tibia
Abstracts
433
Bone scanning for hip fractures Of 693 suspect hips in elderly persons 43 showed no fracture
VASCULAR
on X-ray films and 30 with normal scintigrams were encouraged to get about and came to no harm; the other 13 had abnormalities that signified fracture and 5 of the fractures became displaced. Fairclough J., Colhoun E., Johnston D. et al. (1987) Bone scanning for suspected hip fractures. J. Bone Joint Surg. 69B,
Fifty-one patients with severe injuries of the liver were treated; 29 survived. Nine were treated by passing a cuffed endotracheal tube downwards through the atrial appendage to reach below the hepatic veins; eight of these had tears of the inferior vena cava and/or the hepatic veins and four made good recoveries. Rovito P. F. (1987) Atrial caval shunting in blunt hepatic injury. Ann. Surg. 205, 318.
251. Stress fractures of the tibia
Three women developed slow fractures in the upper half or less of the tibia. The affected knees had well over 90” of movement. Three patients had had tablets or injections for their pain. Satku K., Kumar V. P. and Pho R. W. H. (1987) Stress fractures of the tibia in osteoarthritis of the knee. J. Bone Joint Surg. 69B, 309. Fracture-dislocation
of manubriosternal
joint
Forced flexion of the upper part of the thoracic spine in the course of a major fit caused a crush fracture of the body of T7 as well as dislocating the manubriosternal joint. Dastgeer G. M. and Mikolich D. J. (1987) Fracturedislocation of manubriosternal joint: an unusual complication of seizures. J. Trauma. 27, 91.
INJURIES
Atrial caval shunting
ORGANIZATION PREVENTION
TOPICS
AND
ACCIDENT
Efficiency in use of X-ray examinations
Doctors in their first year after full registration did not become more selective in their use of X-rays but the errors of diagnosis fell from 7 per cent to 3 per cent. One error in four was of clinical importance. Ways of reducing requests for X-ray examinations are proposed. Gleadhill D. N. S., Thomson J. Y. and Simms P. (1987) Can more efficient use be made of X-ray examinations in accident and emergency departments? Br. Med. J. 294, 943.
Results of quadricepsplasty
HAND
Of 9 victims of low fractures of the femur with stiffness of the knee sufficient to prevent a normal gait, 8 regained a normal gait after quadricepsplasty. The average range of movement increased from 30 to 78”. Moore T. J., Harwin C., Green S. A., Garland D. E. and Chandler R. W. (1987) The results of quadricepsplasty on knee motion following femoral fractures. J. Trauma 27, 49.
INJURIES
Tinel’s sign and the carpal tunnel syndrome
Tapping the median nerve at the hyperextended wrist with a patella hammer was more reliable than tapping or pressing with the fingers or merely flexing or extending the wrist. Mossmann S. S. and Blair J. N. (1987) Tinel’s sign and the carpal tunnel syndrome. Br. Med. J. 294, 680.
RECREATIONAL TENDONS
AND
Cruciate ligament
LIGAMENTS reconstruction
It made no difference to the stability of the knee whether or not the repair was supplemented by transferring the tendon. Roth J. H., Kennedy J. C., Lockstadt H., McCallum C. L. and Cunning L. A. (1987) Intra-articular reconstruction of the anterior cruciate ligament with and without extraarticular supplementation by transfer of the biceps tendon.
Suprascapular Of 96 leading
INJURIES neuropathy
volleyball players I2 were found to have symptomless wasting of the infraspinatus with evidence of denervation. This was attributed to repeated stretching of the nerve during cocking the arm and following through. Ferretti A., Gerullo G. and Russo G. (1987) Suprascapular neuropathy in volleyball players. J. Bone Joint Surg. 69A, 260.
J. Bone Joint Surg. 69A, 275.
Role of the posterolateral
and cruciate ligaments
MISCELLANEOUS Pronator syndrome
This biomechanical study showed that the posterolateral ligaments did much to prevent posterior translation, varus angulation and lateral rotation of the tibia. Isolated injury of the posterior cruciate ligament does little to make the knee unstable unless it is bent by more than about 30” but if both this ligament and the posterolateral ligaments are torn the knee will be unstable when straight or nearly straight as well. Gollehon D. L.. Torzilli P. A. and Warren R. F. (1987) The role of the posterolateral and cruciate ligaments in the stability of the human knee. J. Bone Joint Surg. 69A. 233.
A man developed symptoms of median nerve paresis with pain in the forearm; they were exacerbated by exercise and were found to result from a persistent median artery that pierced the median nerve near the origin of the anterior interosseous nerve. The anomalous artery and vein were ligated and divided; the symptoms disappeared. Gainor B. J. and Jeffries J. T. (1987) Pronator syndrome associated with a persistent median artery. J. Bone Joint
Tendon repair
Wound strength
Forty-four digits with both tendons cut yielded 98 per cent of good or excellent results. Primary and delayed repairs yielded comparable results. Chow J. A., Thomas L. J., Dovelle S., Milnor W. H., Seyfer A. E. and Smith A. C. (1987) A combined regimen of controlled motion following tendon repair in ‘no man’s land’.
When tested after 22 days, laparotomy wounds in rats that had been bled were 36 per cent weaker in the skin and 22 per cent weaker in the muscle than were those in rats that had not been bled. Taylor D. E. M., Whamond J. S. and Penhallow J. E. (1987) The effect of haemorrhage on wound strength and fibroblast function. Br. J. Surg. 74. 316.
Plast. Reconstr. Surg. 79, 447.
Surg. 69A, 303.
and fibroblast
function
433
Bone scanning for hip fractures Of 693 suspect hips in elderly persons 43 showed no fracture
VASCULAR
on X-ray films and 30 with normal scintigrams were encouraged to get about and came to no harm; the other 13 had abnormalities that signified fracture and 5 of the fractures became displaced. Fairclough J., Colhoun E., Johnston D. et al. (1987) Bone scanning for suspected hip fractures. J. Bone Joint Surg. 69B,
Fifty-one patients with severe injuries of the liver were treated; 29 survived. Nine were treated by passing a cuffed endotracheal tube downwards through the atrial appendage to reach below the hepatic veins; eight of these had tears of the inferior vena cava and/or the hepatic veins and four made good recoveries. Rovito P. F. (1987) Atrial caval shunting in blunt hepatic injury. Ann. Surg. 205, 318.
251. Stress fractures of the tibia
Three women developed slow fractures in the upper half or less of the tibia. The affected knees had well over 90” of movement. Three patients had had tablets or injections for their pain. Satku K., Kumar V. P. and Pho R. W. H. (1987) Stress fractures of the tibia in osteoarthritis of the knee. J. Bone Joint Surg. 69B, 309. Fracture-dislocation
of manubriosternal
joint
Forced flexion of the upper part of the thoracic spine in the course of a major fit caused a crush fracture of the body of T7 as well as dislocating the manubriosternal joint. Dastgeer G. M. and Mikolich D. J. (1987) Fracturedislocation of manubriosternal joint: an unusual complication of seizures. J. Trauma. 27, 91.
INJURIES
Atrial caval shunting
ORGANIZATION PREVENTION
TOPICS
AND
ACCIDENT
Efficiency in use of X-ray examinations
Doctors in their first year after full registration did not become more selective in their use of X-rays but the errors of diagnosis fell from 7 per cent to 3 per cent. One error in four was of clinical importance. Ways of reducing requests for X-ray examinations are proposed. Gleadhill D. N. S., Thomson J. Y. and Simms P. (1987) Can more efficient use be made of X-ray examinations in accident and emergency departments? Br. Med. J. 294, 943.
Results of quadricepsplasty
HAND
Of 9 victims of low fractures of the femur with stiffness of the knee sufficient to prevent a normal gait, 8 regained a normal gait after quadricepsplasty. The average range of movement increased from 30 to 78”. Moore T. J., Harwin C., Green S. A., Garland D. E. and Chandler R. W. (1987) The results of quadricepsplasty on knee motion following femoral fractures. J. Trauma 27, 49.
INJURIES
Tinel’s sign and the carpal tunnel syndrome
Tapping the median nerve at the hyperextended wrist with a patella hammer was more reliable than tapping or pressing with the fingers or merely flexing or extending the wrist. Mossmann S. S. and Blair J. N. (1987) Tinel’s sign and the carpal tunnel syndrome. Br. Med. J. 294, 680.
RECREATIONAL TENDONS
AND
Cruciate ligament
LIGAMENTS reconstruction
It made no difference to the stability of the knee whether or not the repair was supplemented by transferring the tendon. Roth J. H., Kennedy J. C., Lockstadt H., McCallum C. L. and Cunning L. A. (1987) Intra-articular reconstruction of the anterior cruciate ligament with and without extraarticular supplementation by transfer of the biceps tendon.
Suprascapular Of 96 leading
INJURIES neuropathy
volleyball players I2 were found to have symptomless wasting of the infraspinatus with evidence of denervation. This was attributed to repeated stretching of the nerve during cocking the arm and following through. Ferretti A., Gerullo G. and Russo G. (1987) Suprascapular neuropathy in volleyball players. J. Bone Joint Surg. 69A, 260.
J. Bone Joint Surg. 69A, 275.
Role of the posterolateral
and cruciate ligaments
MISCELLANEOUS Pronator syndrome
This biomechanical study showed that the posterolateral ligaments did much to prevent posterior translation, varus angulation and lateral rotation of the tibia. Isolated injury of the posterior cruciate ligament does little to make the knee unstable unless it is bent by more than about 30” but if both this ligament and the posterolateral ligaments are torn the knee will be unstable when straight or nearly straight as well. Gollehon D. L.. Torzilli P. A. and Warren R. F. (1987) The role of the posterolateral and cruciate ligaments in the stability of the human knee. J. Bone Joint Surg. 69A. 233.
A man developed symptoms of median nerve paresis with pain in the forearm; they were exacerbated by exercise and were found to result from a persistent median artery that pierced the median nerve near the origin of the anterior interosseous nerve. The anomalous artery and vein were ligated and divided; the symptoms disappeared. Gainor B. J. and Jeffries J. T. (1987) Pronator syndrome associated with a persistent median artery. J. Bone Joint
Tendon repair
Wound strength
Forty-four digits with both tendons cut yielded 98 per cent of good or excellent results. Primary and delayed repairs yielded comparable results. Chow J. A., Thomas L. J., Dovelle S., Milnor W. H., Seyfer A. E. and Smith A. C. (1987) A combined regimen of controlled motion following tendon repair in ‘no man’s land’.
When tested after 22 days, laparotomy wounds in rats that had been bled were 36 per cent weaker in the skin and 22 per cent weaker in the muscle than were those in rats that had not been bled. Taylor D. E. M., Whamond J. S. and Penhallow J. E. (1987) The effect of haemorrhage on wound strength and fibroblast function. Br. J. Surg. 74. 316.
Plast. Reconstr. Surg. 79, 447.
Surg. 69A, 303.
and fibroblast
function