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Fat embolism in hip fractures
185
Injury, 4, 185-188
Abstracts FRACTURES Fracture
AND
of the femoral
DISLOCATIONS neck in children
This was the subject of ’ Fracture of the Month’ at Massachusetts General Hospital Fracture Clinic, Boston. Although a rare injury it was of importance clinically because of the reported high incidence of complications, i.e., growth disturbance, vascular impairment. of the head of the femur, and residual deformity. The injury is usually the result of a highspeed road traffic accident and is frequently accompanied by other serious injuries which may delay the definitive treatment of the fracture. Dr. Cary preferred gentle manipulation and if necessary open reduction with fixation by pins with careful avoidance of injury to periosteum, and to be followed by a hip spica, because conservative treatment often failed. Dr. Cary warned that avascular necrosis of the head of the femur may not be in evidence for one year. Premature fusion of the epiphysis could only be established by prolonged follow-up and indicated the need for epiphyseodesis on the other side. Dr. Butler described the treatment of a lo-year-old girl by conservative means (Russell traction with marked abduction for 8 weeks followed by 8 weeks in a hip spica). Dr. Aufranc pointed out that at this early age considerable remodelling could be counted on to correct residual deformity. BUTLER,J. E., and CARY, J. M. (1972), ‘ Fracture of the femoral neck in a child ‘, J. Am. med. Ass., 218, 398.
FAT
EMBOLISM
Fat embolism
in hip fractures
The study is based on 854 persons with fractures of the neck or trochanteric region of the femur. The diagnosis of fat embolism was based on generally accepted clinical evidence, or upon histological evidence in the 46 patients that died within a fortnight of fracture or operation and were subjected to necropsy; 18 others died within a fortnight but were not subjected to necropsy. The results obtained suggested that subcapital fracture of the neck of the femur was more likely than trochanteric fracture to cause fat embolism, and that with the very much smaller number of fractures of the base of the neck the likelihood was greater still. The fact that patients not operated on appeared to be at greater risk than those that were operated on may have reflected their poorer
condition. The different forms of internal fixation had similar rates of fat embolism but one of the most striking findings was that whereas the use of Moore’s prosthesis in 25 patients was in only 1 case followed by fat embolism, which was mild, fat embolism was diagnosed in 7 of 103 patients treated with Thompson’s prosthesis and was judged to have been of fatal degree in 4 of 9 patients subjected to necropsy within 14 days of fracture. The high intramedullary pressures generated by the use of cement may play a part in producing this alarmingly high proportion and further study is recommended. SEVI~~, S. (1972), ‘ Fat embolism in patients with fractured hips ‘, Br. med. J., 2,257.
RECREATtONAL Basketballer’s
INJURIES
knee
Dr. Blazina reports on a ‘near epidemic’ of sports injury to knee known variously as basketballer’s, jumper’s, volleyballer’s, cross-country runner’s, place kicker’s and high diver’s knee. The diagnosis frequently given includes patellar tendinitis, SindigLarsen-Johannsson’s disease or osteochondritis of the patella. Diagnosis is made by palpation of the tender area when symptoms persist. Dr. Blazina and three of his orthopaedic colleagues treated 150 patients at U.C.L.A., 8 of whom came to operation (resection of lower pole of patella and adjacent patellar tendon with reattachment of tendon through holes made in the patella and followed by a plaster cylinder for 6 weeks). Conservative treatment is symptomatic. Results seemed to be related to the type of sport or athletics involved and if ignored and actively continued could be followed by rupture of the patellar tendon. Dr. Blazina thinks the pathology consists of repeated micro-tears in the patellar tendon. BLAZINA,M. E. (1972), ‘ New “epidemic” condition -“Basketballer’s knee” ‘, J. Am. med. Ass., 218, 330. Stock-car A stock-car
kidney
racing driver was found to have mild hypertension and marked scarring of the lower poles of the kidneys, without discernible alteration in the condition of the calyces. The urographic and arteriographic appearances were not those of chronic pyelonephritis of childhood nor of disease of the renal arteries. The condition was ascribed to repeated injury. Stock-car drivers seek as many collisions as
Injury, 4, 185-188
Abstracts FRACTURES Fracture
AND
of the femoral
DISLOCATIONS neck in children
This was the subject of ’ Fracture of the Month’ at Massachusetts General Hospital Fracture Clinic, Boston. Although a rare injury it was of importance clinically because of the reported high incidence of complications, i.e., growth disturbance, vascular impairment. of the head of the femur, and residual deformity. The injury is usually the result of a highspeed road traffic accident and is frequently accompanied by other serious injuries which may delay the definitive treatment of the fracture. Dr. Cary preferred gentle manipulation and if necessary open reduction with fixation by pins with careful avoidance of injury to periosteum, and to be followed by a hip spica, because conservative treatment often failed. Dr. Cary warned that avascular necrosis of the head of the femur may not be in evidence for one year. Premature fusion of the epiphysis could only be established by prolonged follow-up and indicated the need for epiphyseodesis on the other side. Dr. Butler described the treatment of a lo-year-old girl by conservative means (Russell traction with marked abduction for 8 weeks followed by 8 weeks in a hip spica). Dr. Aufranc pointed out that at this early age considerable remodelling could be counted on to correct residual deformity. BUTLER,J. E., and CARY, J. M. (1972), ‘ Fracture of the femoral neck in a child ‘, J. Am. med. Ass., 218, 398.
FAT
EMBOLISM
Fat embolism
in hip fractures
The study is based on 854 persons with fractures of the neck or trochanteric region of the femur. The diagnosis of fat embolism was based on generally accepted clinical evidence, or upon histological evidence in the 46 patients that died within a fortnight of fracture or operation and were subjected to necropsy; 18 others died within a fortnight but were not subjected to necropsy. The results obtained suggested that subcapital fracture of the neck of the femur was more likely than trochanteric fracture to cause fat embolism, and that with the very much smaller number of fractures of the base of the neck the likelihood was greater still. The fact that patients not operated on appeared to be at greater risk than those that were operated on may have reflected their poorer
condition. The different forms of internal fixation had similar rates of fat embolism but one of the most striking findings was that whereas the use of Moore’s prosthesis in 25 patients was in only 1 case followed by fat embolism, which was mild, fat embolism was diagnosed in 7 of 103 patients treated with Thompson’s prosthesis and was judged to have been of fatal degree in 4 of 9 patients subjected to necropsy within 14 days of fracture. The high intramedullary pressures generated by the use of cement may play a part in producing this alarmingly high proportion and further study is recommended. SEVI~~, S. (1972), ‘ Fat embolism in patients with fractured hips ‘, Br. med. J., 2,257.
RECREATtONAL Basketballer’s
INJURIES
knee
Dr. Blazina reports on a ‘near epidemic’ of sports injury to knee known variously as basketballer’s, jumper’s, volleyballer’s, cross-country runner’s, place kicker’s and high diver’s knee. The diagnosis frequently given includes patellar tendinitis, SindigLarsen-Johannsson’s disease or osteochondritis of the patella. Diagnosis is made by palpation of the tender area when symptoms persist. Dr. Blazina and three of his orthopaedic colleagues treated 150 patients at U.C.L.A., 8 of whom came to operation (resection of lower pole of patella and adjacent patellar tendon with reattachment of tendon through holes made in the patella and followed by a plaster cylinder for 6 weeks). Conservative treatment is symptomatic. Results seemed to be related to the type of sport or athletics involved and if ignored and actively continued could be followed by rupture of the patellar tendon. Dr. Blazina thinks the pathology consists of repeated micro-tears in the patellar tendon. BLAZINA,M. E. (1972), ‘ New “epidemic” condition -“Basketballer’s knee” ‘, J. Am. med. Ass., 218, 330. Stock-car A stock-car
kidney
racing driver was found to have mild hypertension and marked scarring of the lower poles of the kidneys, without discernible alteration in the condition of the calyces. The urographic and arteriographic appearances were not those of chronic pyelonephritis of childhood nor of disease of the renal arteries. The condition was ascribed to repeated injury. Stock-car drivers seek as many collisions as