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A DEATACHABLE CURTAIN-RAIL
297
It was essential to preserve as much innervation of the lower limbs as possible. Loss of even one root, especially lower lumbar or sacral, might make all the difference to the child’s ability to walk or obtain some measure of urinary control. There was much more satisfactory preservation of muscle innervation with immediate emergency closure than with conservative treatment or delayed closure. Orthopaedic treatment was also easier with a sound scar instead of a tender swelling liable to ulceration. In many cases of lumbar or lumbosacral meningocele or meningomyelocele there is a cauda-equina lesion sparing one or more roots-usually the upper ones. Alternatively there might be an upper-motor-neurone lesion of the sacral segments and a lower-motor-neurone lesion of the lumbar roots. There might be multiple deformities of hips, knees, and feet which might be mistaken for arthrogryposis multiplex. The common pattern of deformity was flexion, adduction, external rotation, and dislocation of the hip, with extension or hyperextension of the knee and a varus or calcaneovarus foot associated with strong activity in ileopsoas, sartorius, hip adductors, quadriceps, and tibialis anterior, and complete paralysis of all other lower-limb muscles. This indicated innervation from the upper 4 lumbar segments with paralysis of muscles innervated by roots below this level. The deformities, including hip dislocation, appeared therefore to be secondary to paralysis.
New Inventions A DETACHABLE CURTAIN-RAIL outbreak of staphylococcal diarrhoea at the Radcliffe Infimiary,l the cotton cubicle and window curtains in the wards were found to be a reservoir for epidemic strains of Staphylococcus aureus. To unhook all these curtains and replace IN
1.
an
J., Elliott, C., Elliot-Smith, A., Frisby, Cook, Brit.
B.
med. J. 1957, i, 542.
R., Gardner, A. M. N.
found that dislocation never occurred where there was T12 and only very rarely and in later years where innervation was present down to Ll or L2. Where innervation was present down to L3 or L4 there was a high prevalence of dislocation at birth, and in all such cases dislocation was present by the end of the first year. With innervation down to and including L5 there were no dislocations at birth but some dislocation after the second year. With innervation below this level there were virtually no dislocations. Dislocation was most usual when the flexors and adductors were fully innervated and abductors and extensors paralysed. Complete paralysis or complete innervation of both groups of muscles resulted in a stable hip. The mechanism of the deformities of the foot could also be analysed in terms of unapposed activity of unaffected muscles. This knowledge had shown that dislocation must be followed by transplantation of deforming muscles through the ilium to the posterior aspect of the greater trochanter. Similar considerations applied in the treatment of foot deformities by operative division to correct soft-tissue shortening followed by tendon transplantation. These children were liable to all the complications that occurred in paraplegic patients, and conventional methods of treating dislocation of the hip or deformity of the foot must not be used, shortened ligaments and tendons being corrected by It
was
complete paralysis below
open surgery.
them took two girls four tedious and exhausting working-hours. The device described below saves time because it is unnecessary to unhook the curtains. Typical cubicle equipment, comprising aluminium tube and curtain-rail with nylon gliders is seen in fig. 1. A detachable section of rail is attached to the tube by two tube-clips fitted with wing-nuts, and to the fixed part of the rail by a special connecting bridge. A gap of 3/4 in. must be left between the end of the detachable section of rail and the wall so that this section can be taken off. Also, the section should be long enough to accommodate all the curtain gliders. The connection with the fixed rail is shown in detail in fig. 2. A metal bridge fits on to the top flange of the rails. It is screwed permanently to the detachable section and can be secured to the fixed rail by a small screw eye. Attached to the bridge is a spring wire clip which, lowered to the bottom flange of the rail, as in the figure, stops the gliders coming off when the rail is detached. This spring clip normally remains against the top flange of the rail. The screw nut on the bridge and the wing-nuts clamping the tube clips can be easily unscrewed when the rail has to be removed. To remove the detachable section of rail:
Fig. 1.
(2)
(1) Arrange the curtain with all the gliders on the detachable section. Lower the spring clip so that the gliders cannot come off this
section. (3) Slacken the tube
screw
eye
on
the
bridge,
and the
wing
nuts on
the
clips.
(4) Remove the rail, complete with curtains. The curtains with the rails are put on a metal trolley and taken to be cleansed. Terylene curtains are dipped in a solution of 1 %Tego ’ MHG2 in a bath and suspended by their rails on a domestic clothes-drying frame fixed to the ceiling. In about half an hour they have dripped dry; and the rails with the curtains can then be rapidly replaced round the beds. The invention can be adapted to fit other types of cubicle rails. These detachable curtain rails are made by Co. Ltd., St. Paul’s Square, Birmingham, 3.
Fig.
2.
’505 ’ Manufacturing
Department of Bacteriology and and$, B. R. R FRISBY FRisi3y Public Health Laboratory, M.D. Lpool Radcliffe Infirmary, Oxford 2. Frisby, B. R. Lancet, 1959, ii, 57.
It was essential to preserve as much innervation of the lower limbs as possible. Loss of even one root, especially lower lumbar or sacral, might make all the difference to the child’s ability to walk or obtain some measure of urinary control. There was much more satisfactory preservation of muscle innervation with immediate emergency closure than with conservative treatment or delayed closure. Orthopaedic treatment was also easier with a sound scar instead of a tender swelling liable to ulceration. In many cases of lumbar or lumbosacral meningocele or meningomyelocele there is a cauda-equina lesion sparing one or more roots-usually the upper ones. Alternatively there might be an upper-motor-neurone lesion of the sacral segments and a lower-motor-neurone lesion of the lumbar roots. There might be multiple deformities of hips, knees, and feet which might be mistaken for arthrogryposis multiplex. The common pattern of deformity was flexion, adduction, external rotation, and dislocation of the hip, with extension or hyperextension of the knee and a varus or calcaneovarus foot associated with strong activity in ileopsoas, sartorius, hip adductors, quadriceps, and tibialis anterior, and complete paralysis of all other lower-limb muscles. This indicated innervation from the upper 4 lumbar segments with paralysis of muscles innervated by roots below this level. The deformities, including hip dislocation, appeared therefore to be secondary to paralysis.
New Inventions A DETACHABLE CURTAIN-RAIL outbreak of staphylococcal diarrhoea at the Radcliffe Infimiary,l the cotton cubicle and window curtains in the wards were found to be a reservoir for epidemic strains of Staphylococcus aureus. To unhook all these curtains and replace IN
1.
an
J., Elliott, C., Elliot-Smith, A., Frisby, Cook, Brit.
B.
med. J. 1957, i, 542.
R., Gardner, A. M. N.
found that dislocation never occurred where there was T12 and only very rarely and in later years where innervation was present down to Ll or L2. Where innervation was present down to L3 or L4 there was a high prevalence of dislocation at birth, and in all such cases dislocation was present by the end of the first year. With innervation down to and including L5 there were no dislocations at birth but some dislocation after the second year. With innervation below this level there were virtually no dislocations. Dislocation was most usual when the flexors and adductors were fully innervated and abductors and extensors paralysed. Complete paralysis or complete innervation of both groups of muscles resulted in a stable hip. The mechanism of the deformities of the foot could also be analysed in terms of unapposed activity of unaffected muscles. This knowledge had shown that dislocation must be followed by transplantation of deforming muscles through the ilium to the posterior aspect of the greater trochanter. Similar considerations applied in the treatment of foot deformities by operative division to correct soft-tissue shortening followed by tendon transplantation. These children were liable to all the complications that occurred in paraplegic patients, and conventional methods of treating dislocation of the hip or deformity of the foot must not be used, shortened ligaments and tendons being corrected by It
was
complete paralysis below
open surgery.
them took two girls four tedious and exhausting working-hours. The device described below saves time because it is unnecessary to unhook the curtains. Typical cubicle equipment, comprising aluminium tube and curtain-rail with nylon gliders is seen in fig. 1. A detachable section of rail is attached to the tube by two tube-clips fitted with wing-nuts, and to the fixed part of the rail by a special connecting bridge. A gap of 3/4 in. must be left between the end of the detachable section of rail and the wall so that this section can be taken off. Also, the section should be long enough to accommodate all the curtain gliders. The connection with the fixed rail is shown in detail in fig. 2. A metal bridge fits on to the top flange of the rails. It is screwed permanently to the detachable section and can be secured to the fixed rail by a small screw eye. Attached to the bridge is a spring wire clip which, lowered to the bottom flange of the rail, as in the figure, stops the gliders coming off when the rail is detached. This spring clip normally remains against the top flange of the rail. The screw nut on the bridge and the wing-nuts clamping the tube clips can be easily unscrewed when the rail has to be removed. To remove the detachable section of rail:
Fig. 1.
(2)
(1) Arrange the curtain with all the gliders on the detachable section. Lower the spring clip so that the gliders cannot come off this
section. (3) Slacken the tube
screw
eye
on
the
bridge,
and the
wing
nuts on
the
clips.
(4) Remove the rail, complete with curtains. The curtains with the rails are put on a metal trolley and taken to be cleansed. Terylene curtains are dipped in a solution of 1 %Tego ’ MHG2 in a bath and suspended by their rails on a domestic clothes-drying frame fixed to the ceiling. In about half an hour they have dripped dry; and the rails with the curtains can then be rapidly replaced round the beds. The invention can be adapted to fit other types of cubicle rails. These detachable curtain rails are made by Co. Ltd., St. Paul’s Square, Birmingham, 3.
Fig.
2.
’505 ’ Manufacturing
Department of Bacteriology and and$, B. R. R FRISBY FRisi3y Public Health Laboratory, M.D. Lpool Radcliffe Infirmary, Oxford 2. Frisby, B. R. Lancet, 1959, ii, 57.