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Failed anterior shoulder reconstruction
Abstracts
283
Failed anterior shoulder reconstruction
Thirty-one out of 46 reconstructions remained unstable because of an uncorrected defect, failure to recognize that a dislocation was posterior or because of further violence. Pain could result for a number of reasons, including late arthritis from over-shortening of the capsule in front. Hawkins R. H. and Hawkins R. J. (1985) Failed anterior reconstruction for shoulder instability. J. Bone Joint Surg. 67B, 709.
Ender’s nails for delayed union
Ten humeri were nailed with Ender’s nails because they showed no evidence of union at 6152. Bone grafts and external splintage were not used. Nine fractures united, one required compression plating and a bone graft and in one other the nails slid out and had to be replaced. Pritchett J. W. (1985) Delayed union of humeral shaft fractures treated by closed flexible intramedullary nailing. J. Bone Joint Surg. 67B, 715.
brain, chest or belly. None died. There is no mention of the place of fixation of fractures in such cases. Modig J., Hedstrand U. and Wegenius G. (1985) Determinants of early adult respiratory distress syndrome. Acta Chir. Stand. 151, 413. Opsonic substances
and sepsis
All of 362 injured persons showed a fall in the serum levels of complements 3 and 4 and this lasted about 1 week. C-reactive protein rose by 12 hours and reached a maximum at 48 hours; if it was still raised after 4 days this indicated infection, which became clinically manifest, on average, 2% days later. Stahl W., Singh A. and Marcus M. (1985) Responses of opsonic substances to major trauma and sepsis. Crit. Care Med. 13, 779. ORGANJZATION Use of deffbrillators
AND ACCJDENT PREVENTION by ambulance
crews
All but 3 of 39 patients derived considerable benefit from osteotomy, wedge grafts and plating. Old persons and those with fractures into the wrist joint were excluded from the study. Ekenstam F. A. F., Hagert C. G., Engkvist O., Tomvall A. H. and Wilbrand H. (1985) Corrective osteotomy of malunited fractures of the distal end of the radius. Stand. J.
Defibrillators are now standard equipment for accident and emergency ambulances in Nottingham and, together with suitable training, have saved lives that would previously have been expected to die. Twenty out of 72 who developed fibrillation reached hospital alive and 13 went home. With 44 other sorts of cardiac arrest the figures were, respectively, 7 and 4. Rowley J. M., Garner C., Hardy M. and Hampton J. R. (1985) Simple training programme for ambulance personnel in the management of cardiac arrest in the community. Br.
Radiography
Med. J. 291, 1099.
Corrective osteotomy
of radial fractures
Plast. Reconstr. Surg. 19, 175.
in A&E departments
An investigation by the Royal College of Radiologists showed that the proportion of fractures found varied from 21 to 34 per cent in different centres. Only 10 of nearly 2500 patients with fractures were not at first radiographed. Fractures were suspected in SOper cent of cases and found in 25 per cent, but 21 per cent of bony injuries found had not been expected from the clinical findings. It is worth noting that the clinical examination required by the study was more thorough than that recorded by most casualty officers. Evans K. T. et al. (1985) Radiography of injured arms and legs in eight accident and emergency departments in England and Wales. Br. Med. J. 291, 1325. VASCULAR Follow-up
INJURIES of venous repairs
In the small proportion of patients seen years after reconstruction, the veins were patent and their valves efficacious, with no sign of venous failure. Phifer T. J., Gerlock A. D., Rich N. M. and McDonald J. C. (1985) Long-term patency of venous repairs demonstrated by venography. J. Trauma 25, 342. BURNS Skeletal
immobilization
The methods used were traction in frames and were satisfactory with circumferential grafts; for fractures into joints and for injured tendons, simple splintage is recommended. Serious infections were rare. Harnar I., Engran L., Heimback D. and Marvin J. A. (1985) Experience with skeletal immobilization after incision and grafting of severely burned hands. J. Trauma 25, 299. PATHOLOGY Determinants
AND
EXPERIMENTAL
WORK
of ARDS
Two hundred and twenty patients admitted for intensive care had major fractures without serious associated injuries of
Biomechanics
of helmets
One or two persons can safely remove a helmet and it does not seem to be the case that a helmet plays a part in causing injury by hyperextension. The back edge comes into contact with the neck between C6 and l-2, usually with C7 or Tl. The helmet can be used to apply traction and need not be removed unless it is causing choking. Meyer R. D. and Daniel W. D. (1985) Biomechanics of helmets and helmet removal. J. Trauma 25, 329. Car restraints for children
Of 268 children in motor cars one-third were correctly restrained, 44 per cent were not restrained, 10 per cent were in appropriate restrainers and 13 per cent were in incorrectly anchored restraints. Cost and inconvenience were important considerations. Eatough R., Savage T., Willson P. and Broomhall J. (1985) Children in cars: how are they being restrained? Br. Med. J. 291, 1029. Economics of fatal injury
The authors concluded that trauma scores of 1 and 2 offered no prospect of survival and that no more than 106 of those with scores of 3 and 4 survived, at high cost. In discussion, it was reported that survivors could occur with scores of even 1 and 2. Few would withhold or abandon treatment solely because of cost. Fischer R. P., Flynn T. C., Miller P. W. and Rowlands B. J. (1985) The economics of fatal injury; dollars and sense. J. Trauma 25, 746. Injury care costs
Most of this article is not relevant to conditions in Great Britain but the figures of costs may be of interest. Oakes D. D., Holcomb S. F. and Scherck J. P. (1985) Patterns of trauma care costs and reimbursements: the burden of uninsured motorists. J. Trauma 25, 740. Vena caval pressure and PPV
Pressure within the inferior vena cava increases with the increase in the inflating pressure. This is disadvantageous
283
Failed anterior shoulder reconstruction
Thirty-one out of 46 reconstructions remained unstable because of an uncorrected defect, failure to recognize that a dislocation was posterior or because of further violence. Pain could result for a number of reasons, including late arthritis from over-shortening of the capsule in front. Hawkins R. H. and Hawkins R. J. (1985) Failed anterior reconstruction for shoulder instability. J. Bone Joint Surg. 67B, 709.
Ender’s nails for delayed union
Ten humeri were nailed with Ender’s nails because they showed no evidence of union at 6152. Bone grafts and external splintage were not used. Nine fractures united, one required compression plating and a bone graft and in one other the nails slid out and had to be replaced. Pritchett J. W. (1985) Delayed union of humeral shaft fractures treated by closed flexible intramedullary nailing. J. Bone Joint Surg. 67B, 715.
brain, chest or belly. None died. There is no mention of the place of fixation of fractures in such cases. Modig J., Hedstrand U. and Wegenius G. (1985) Determinants of early adult respiratory distress syndrome. Acta Chir. Stand. 151, 413. Opsonic substances
and sepsis
All of 362 injured persons showed a fall in the serum levels of complements 3 and 4 and this lasted about 1 week. C-reactive protein rose by 12 hours and reached a maximum at 48 hours; if it was still raised after 4 days this indicated infection, which became clinically manifest, on average, 2% days later. Stahl W., Singh A. and Marcus M. (1985) Responses of opsonic substances to major trauma and sepsis. Crit. Care Med. 13, 779. ORGANJZATION Use of deffbrillators
AND ACCJDENT PREVENTION by ambulance
crews
All but 3 of 39 patients derived considerable benefit from osteotomy, wedge grafts and plating. Old persons and those with fractures into the wrist joint were excluded from the study. Ekenstam F. A. F., Hagert C. G., Engkvist O., Tomvall A. H. and Wilbrand H. (1985) Corrective osteotomy of malunited fractures of the distal end of the radius. Stand. J.
Defibrillators are now standard equipment for accident and emergency ambulances in Nottingham and, together with suitable training, have saved lives that would previously have been expected to die. Twenty out of 72 who developed fibrillation reached hospital alive and 13 went home. With 44 other sorts of cardiac arrest the figures were, respectively, 7 and 4. Rowley J. M., Garner C., Hardy M. and Hampton J. R. (1985) Simple training programme for ambulance personnel in the management of cardiac arrest in the community. Br.
Radiography
Med. J. 291, 1099.
Corrective osteotomy
of radial fractures
Plast. Reconstr. Surg. 19, 175.
in A&E departments
An investigation by the Royal College of Radiologists showed that the proportion of fractures found varied from 21 to 34 per cent in different centres. Only 10 of nearly 2500 patients with fractures were not at first radiographed. Fractures were suspected in SOper cent of cases and found in 25 per cent, but 21 per cent of bony injuries found had not been expected from the clinical findings. It is worth noting that the clinical examination required by the study was more thorough than that recorded by most casualty officers. Evans K. T. et al. (1985) Radiography of injured arms and legs in eight accident and emergency departments in England and Wales. Br. Med. J. 291, 1325. VASCULAR Follow-up
INJURIES of venous repairs
In the small proportion of patients seen years after reconstruction, the veins were patent and their valves efficacious, with no sign of venous failure. Phifer T. J., Gerlock A. D., Rich N. M. and McDonald J. C. (1985) Long-term patency of venous repairs demonstrated by venography. J. Trauma 25, 342. BURNS Skeletal
immobilization
The methods used were traction in frames and were satisfactory with circumferential grafts; for fractures into joints and for injured tendons, simple splintage is recommended. Serious infections were rare. Harnar I., Engran L., Heimback D. and Marvin J. A. (1985) Experience with skeletal immobilization after incision and grafting of severely burned hands. J. Trauma 25, 299. PATHOLOGY Determinants
AND
EXPERIMENTAL
WORK
of ARDS
Two hundred and twenty patients admitted for intensive care had major fractures without serious associated injuries of
Biomechanics
of helmets
One or two persons can safely remove a helmet and it does not seem to be the case that a helmet plays a part in causing injury by hyperextension. The back edge comes into contact with the neck between C6 and l-2, usually with C7 or Tl. The helmet can be used to apply traction and need not be removed unless it is causing choking. Meyer R. D. and Daniel W. D. (1985) Biomechanics of helmets and helmet removal. J. Trauma 25, 329. Car restraints for children
Of 268 children in motor cars one-third were correctly restrained, 44 per cent were not restrained, 10 per cent were in appropriate restrainers and 13 per cent were in incorrectly anchored restraints. Cost and inconvenience were important considerations. Eatough R., Savage T., Willson P. and Broomhall J. (1985) Children in cars: how are they being restrained? Br. Med. J. 291, 1029. Economics of fatal injury
The authors concluded that trauma scores of 1 and 2 offered no prospect of survival and that no more than 106 of those with scores of 3 and 4 survived, at high cost. In discussion, it was reported that survivors could occur with scores of even 1 and 2. Few would withhold or abandon treatment solely because of cost. Fischer R. P., Flynn T. C., Miller P. W. and Rowlands B. J. (1985) The economics of fatal injury; dollars and sense. J. Trauma 25, 746. Injury care costs
Most of this article is not relevant to conditions in Great Britain but the figures of costs may be of interest. Oakes D. D., Holcomb S. F. and Scherck J. P. (1985) Patterns of trauma care costs and reimbursements: the burden of uninsured motorists. J. Trauma 25, 740. Vena caval pressure and PPV
Pressure within the inferior vena cava increases with the increase in the inflating pressure. This is disadvantageous