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Flexor tendon injuries
70 surrounding cortex. Ingrowth, of bone into titanium-coated prostheses implanted into the femoral neck of dogs has shown some evidence of direct bony apposition, and work with ceramics and other porous coated metal implants also suggests the presence of tissue ingrowth. Significant bony ingrowth capable of resisting the potential shearing forces to which the prosthesis/bone interface is subject is hard to show. One of the principle advantages of an uncemented implant is its ability to be easily revised in the event of sepsis or failure, and significant ingrowth may make revision harder. A number of prostheses currently available are frighteningly difficult to remove-though it must be said that one of the most damaging of all is the cemented arthroplasty! The second half of the book is devoted to clinical results obtained in the insertion of 14 different types of cementless arthroplasty. Two had ceramic coating, four utilized ingrowth properties and six are simple press fit devices. There are two other mechanical forms of fixation. Most reports are of relatively small numbers followed for relatively short periods although a few authors’ experience extended to 7 or 8 years. It would be invidious to single out any one type over another on the evidence presented, although many present encouraging results. Perhaps even more interesting are the five papers on revision or exchange arthroplasty from cemented to cement free. Results can be spectacular in cases where bone loss would appear to doom any revision but where actual regeneration of bone can occur. Again results are short in the follow-up time and numbers, The book is really for those with a special interest in the broad subject of arthroplasty and should not be for the tyro ‘looking for a cement free replacement’. C. J. HOWELL
Injury: the British Journal of Accident Surgen/ (1986)Vol. 17/No. 1 Flexor Tendon Injuries. L. H. Schneider.
254xl86mm. Pp. 184. 1985. Boston: Little Brown. $42.50. Hardback. This is a magnificent monograph on flexor tendon injuriespractical, erudite and with a very thoughtful analysis of the conflicting ideas on all the problems that the surgeon has to face. The author’s extensive clinical experience and his deep knowledge of the subject make him a master. History, anatomy, healing and surgical techniques take the reader into this absorbing account of flexor tendon injuries. Disputes between primary repairs, secondary repairs and tendon grafts have been resolved in favour of primary flexor tendon repair-recent laboratory work has shown the beneficial effect of synovial fluid within the flexor sheath on the healing of flexor tendons in zone 2 thus focusing attention on the need to do a careful suture of the flexor tendon sheath. The author strikes a balance between strength and the technique of suture, early controlled mobilization and full active movement (which he delays for 8-10 weeks). There is a detailed discussion on secondary procedures in flexor tendon surgery, tendon grafts, tenolysis, salvage procedures and methods to evaluate results. The text is lucid and very readable; each chapter is followed by a comprehensive list of references. Surgical techniques are explained by line diagrams, and numerous clinical photographs of clinical cases very adequately support the adjacent text. This book is very welcome and will be much admired throughout the world. T. R. FISHER
Notices FORCES MEDIC ‘86 London, 20-22 May 1986 Forces Medic is the first exhibition of its kind to focus directly on the needs of military medicine and the developments in technology and services related directly to it. Although much of the exhibit will feature equipment of interest to civilian agencies dealing with quick response care and trauma management (such as the emergency services and major, designated A & E departments and civilian authorities such as CEPOs and officers engaged on TI’W planning), the main focus will be towards the needs of the armed forces, law enforcement agencies, special operations and internal security groups. It is worth noting, however, that a great amount of the equipment now available and the skills now practised in civilian emergency care and disaster management are a direct result of the lessons learned from military medicine and combat surgery. From ‘man down’, to triage and throughput for further care, Forces Medic will cover the variety of skills, equipment, pharmaceuticals and services for use in military medicine, combat survival and disaster management. Personal and professional skills, surgery, diagnosis, medication and self-treatment, coupled with the latest technological and training developments, will be backed up with a programme of practically orientated seminars by specialists in their fields. Also featured will be the latest equipment for use in hostile environments such as the operational and NBC
fields. This will cover detection of the NBC threat, specialist protective clothing, respiratory filters, air/water purification and decontamination processes. Forces Medic is not a show for the general public or those with a general interest. It is specifically for those whose opinions are required and whose recommendations carry weight in the procurement or purchasing process. The strict attendance profile will ensure that international visitors and exhibitors alike will derive maximum benefit from the event in a relaxed yet secure atmosphere. International visitors will come from the following broad groups: Army; Navy, Air Force; special forces; police; diplomatic staff; government departments and ministries; CEPOs; operational research institutions; major A & E units; emergency services; international relief agencies; teaching establishments; Custom and coast guards; airlines and shipping; corporate protection consultants; technicians and specialists. Further details are available from Osprey Exhibitions, 67 Linden Lea, Garston, Watford, Hertfordshire WD2 7DW. Tel. 0923 675052. Military Surgical Society Birmingham, 26 April 1986 Further details of this meeting can be obtained from the Secretary, R. Myles Gibson, TD. FRCS(Edin), Royal College of Surgeons of Edinburgh.
Injury: the British Journal of Accident Surgen/ (1986)Vol. 17/No. 1 Flexor Tendon Injuries. L. H. Schneider.
254xl86mm. Pp. 184. 1985. Boston: Little Brown. $42.50. Hardback. This is a magnificent monograph on flexor tendon injuriespractical, erudite and with a very thoughtful analysis of the conflicting ideas on all the problems that the surgeon has to face. The author’s extensive clinical experience and his deep knowledge of the subject make him a master. History, anatomy, healing and surgical techniques take the reader into this absorbing account of flexor tendon injuries. Disputes between primary repairs, secondary repairs and tendon grafts have been resolved in favour of primary flexor tendon repair-recent laboratory work has shown the beneficial effect of synovial fluid within the flexor sheath on the healing of flexor tendons in zone 2 thus focusing attention on the need to do a careful suture of the flexor tendon sheath. The author strikes a balance between strength and the technique of suture, early controlled mobilization and full active movement (which he delays for 8-10 weeks). There is a detailed discussion on secondary procedures in flexor tendon surgery, tendon grafts, tenolysis, salvage procedures and methods to evaluate results. The text is lucid and very readable; each chapter is followed by a comprehensive list of references. Surgical techniques are explained by line diagrams, and numerous clinical photographs of clinical cases very adequately support the adjacent text. This book is very welcome and will be much admired throughout the world. T. R. FISHER
Notices FORCES MEDIC ‘86 London, 20-22 May 1986 Forces Medic is the first exhibition of its kind to focus directly on the needs of military medicine and the developments in technology and services related directly to it. Although much of the exhibit will feature equipment of interest to civilian agencies dealing with quick response care and trauma management (such as the emergency services and major, designated A & E departments and civilian authorities such as CEPOs and officers engaged on TI’W planning), the main focus will be towards the needs of the armed forces, law enforcement agencies, special operations and internal security groups. It is worth noting, however, that a great amount of the equipment now available and the skills now practised in civilian emergency care and disaster management are a direct result of the lessons learned from military medicine and combat surgery. From ‘man down’, to triage and throughput for further care, Forces Medic will cover the variety of skills, equipment, pharmaceuticals and services for use in military medicine, combat survival and disaster management. Personal and professional skills, surgery, diagnosis, medication and self-treatment, coupled with the latest technological and training developments, will be backed up with a programme of practically orientated seminars by specialists in their fields. Also featured will be the latest equipment for use in hostile environments such as the operational and NBC
fields. This will cover detection of the NBC threat, specialist protective clothing, respiratory filters, air/water purification and decontamination processes. Forces Medic is not a show for the general public or those with a general interest. It is specifically for those whose opinions are required and whose recommendations carry weight in the procurement or purchasing process. The strict attendance profile will ensure that international visitors and exhibitors alike will derive maximum benefit from the event in a relaxed yet secure atmosphere. International visitors will come from the following broad groups: Army; Navy, Air Force; special forces; police; diplomatic staff; government departments and ministries; CEPOs; operational research institutions; major A & E units; emergency services; international relief agencies; teaching establishments; Custom and coast guards; airlines and shipping; corporate protection consultants; technicians and specialists. Further details are available from Osprey Exhibitions, 67 Linden Lea, Garston, Watford, Hertfordshire WD2 7DW. Tel. 0923 675052. Military Surgical Society Birmingham, 26 April 1986 Further details of this meeting can be obtained from the Secretary, R. Myles Gibson, TD. FRCS(Edin), Royal College of Surgeons of Edinburgh.