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High-pressure water jet injury
146
Chest physiotherapy following respiratory failure Physiotherapists' efforts to remove retained secretions were followed by reduced shunting within the lungs and improved compliance, without the fall in cardiac output or hypoxaemia reported by others. Mackenzie C. F. and Shin B. (1985) Cardiorespiratory function before and after chest physiotherapy in mechanically ventilated patients with post-traumatic respiratory failure. Crit. Care Med. 13, 483.
Injury: the British Journal of Accident Surgery (1986) Vol. 17/No. 2
lization. The best results were obtained with wounds that were circumferential or extended onto the forearm. Serious infective complications directly attributable to the skeletal traction were rare and peripheral nerve and arterial injuries were not observed. The technique appears to be safe and results in excellent sheet graft take and hand function; it is, however, not recommended when joints or tendons are involved or when the hand is easily splinted. Harnar T., Engrav L., Heimbach D. et al. (1985) Experience with skeletal immobilisation after excision and grafting of severely burned hands. J. Trauma 25,299.
FRACTURES A N D DISLOCATIONS Fixation of trochanteric fractures From Rome comes a report comparing the axial stress resistance of three types of fixation for trochanteric fractures of the femur. An Instron press was used and the 15 femoral models were fractured and the reduction held with a McLaughlin nail plate, a 130 ° A O nail plate or three Ender's nails. The Ender's nails performed much better and the author recommends their use for all trochanteric fractures. Amici F., Jr (1985) Three types of fixation for trochanteric fractures of the femur. Minerva Ortop. 36(5).
A new external fixator V. Salvi describes an original design of external fixator which looks rather more complicated than the Wagner device, but it is claimed that it is lighter, easy to apply, self-centring and versatile. The illustrations suggest that this may be true but we should have a fuller account of a case series, and will need to know its cost. Salvi V. (1985) A new unilateral external fixator. Minerva Ortop. 36.
Hyperbaric oxygen during operative treatment Eight cases of very severe crushing injuries and open fractures of the" limbs are reported. Operative treatment was combined with hyperbaric oxygen and the good results obtained were credited to the latter. Two of the cases were complicated by gas gangrene. The authors list advantages of the 2-hour exposure to oxygen at 2-8 atmospheres as: improving postoperative vasodilatation; increasing oxygen tissue perfusion for 4 hours; increasing the new formation of capillaries; activation of osteogenesis; reducing oedema formation; controlling collagen formation; action against anaerobic and aerobic bacteria. Scavaglio et al. (1985) Hyperbaric oxygen in crush injuries and open fractures. Minerva Ortop. 36.
RECREATIONAL INJURIES
Sports injuries A survey of 1652 sporting injuries in Brisbane. Sixty-nine per cent of injuries occurred during competition; 7 per cent were due to foul play in contact sports. Smithers M. and Myers P. T. (1985) Injuries in sport. A prospective casualty study. Med. J. Aust. 142, 457.
BURNS
Use of skeletal immobilization Sixty-eight burned hands were treated using skeletal immobi-
Long-term assessment of treatment of hand burns The long-term effects of early excision and immediate autografting were assessed in 478 patients with 78 per cent hand burns. This procedure provided good to excellent functional results in more than 90 per cent of the hands when the burns were deep dermal or full-thickness skin loss. Poor results were obtained when the injuries were deeper and involved tendons, nerves, bones and joints. In patients with only superficial dermal burns non-surgical treatment with silver nitrate dressings and early physical therapy produced very good results. The authors suggest that all burned hands judged unlikely to heal within 3 weeks will benefit from early excision and grafting by experienced surgical personnel. Frist W., Ackroyd F., Burke J. F. et al. (1985) Long term functional results of selective treatment of hand burns. Am. J. Surg. 149, 516.
H A N D INJURIES High-pressure water jet injury One case is reported, affecting the thumb and little finger, with complete recovery after injection at 5000 p.s.i. Koa M. (1985) High-pressure water jet injury of the hand. J. Hand Surg. 10A, 412.
Dislocation of the proximal interphalangeal joint Eighteen cases are reported. The lesson was that these injuries require careful repair in good conditions if sepsis and even amputation are to be avoided. Stern P. J. and Lee A. F. (1985) Open dorsal dislocations of the proximal interphalangeal joint. J. Hand Surg. 10A, 364.
Metacarpal reconstruction The grafts were successfully incorporated, without visible callus and with a gradual change to the natural texture of the part, supposedly by creeping substitution, in 6-12 months. Smith R. J. and Brushart T. M. (1985) Allograft bone for metacarpal reconstruction. J. Hand Surg. 10A, 325.
Treatment of ring injuries Avulsion of fingers by rings was dealt with energetically by these surgeons. They report a series of 32 cases with details of the methods of reconstruction where feasible and about the timing and level of amputation when this was imperative. They discuss indications and results. They advocate primary microvascular surgery but delayed repair for the other elements. Codega et al. (1985) Treatment of ring injuries. Minerva Ortop. 36.
Chest physiotherapy following respiratory failure Physiotherapists' efforts to remove retained secretions were followed by reduced shunting within the lungs and improved compliance, without the fall in cardiac output or hypoxaemia reported by others. Mackenzie C. F. and Shin B. (1985) Cardiorespiratory function before and after chest physiotherapy in mechanically ventilated patients with post-traumatic respiratory failure. Crit. Care Med. 13, 483.
Injury: the British Journal of Accident Surgery (1986) Vol. 17/No. 2
lization. The best results were obtained with wounds that were circumferential or extended onto the forearm. Serious infective complications directly attributable to the skeletal traction were rare and peripheral nerve and arterial injuries were not observed. The technique appears to be safe and results in excellent sheet graft take and hand function; it is, however, not recommended when joints or tendons are involved or when the hand is easily splinted. Harnar T., Engrav L., Heimbach D. et al. (1985) Experience with skeletal immobilisation after excision and grafting of severely burned hands. J. Trauma 25,299.
FRACTURES A N D DISLOCATIONS Fixation of trochanteric fractures From Rome comes a report comparing the axial stress resistance of three types of fixation for trochanteric fractures of the femur. An Instron press was used and the 15 femoral models were fractured and the reduction held with a McLaughlin nail plate, a 130 ° A O nail plate or three Ender's nails. The Ender's nails performed much better and the author recommends their use for all trochanteric fractures. Amici F., Jr (1985) Three types of fixation for trochanteric fractures of the femur. Minerva Ortop. 36(5).
A new external fixator V. Salvi describes an original design of external fixator which looks rather more complicated than the Wagner device, but it is claimed that it is lighter, easy to apply, self-centring and versatile. The illustrations suggest that this may be true but we should have a fuller account of a case series, and will need to know its cost. Salvi V. (1985) A new unilateral external fixator. Minerva Ortop. 36.
Hyperbaric oxygen during operative treatment Eight cases of very severe crushing injuries and open fractures of the" limbs are reported. Operative treatment was combined with hyperbaric oxygen and the good results obtained were credited to the latter. Two of the cases were complicated by gas gangrene. The authors list advantages of the 2-hour exposure to oxygen at 2-8 atmospheres as: improving postoperative vasodilatation; increasing oxygen tissue perfusion for 4 hours; increasing the new formation of capillaries; activation of osteogenesis; reducing oedema formation; controlling collagen formation; action against anaerobic and aerobic bacteria. Scavaglio et al. (1985) Hyperbaric oxygen in crush injuries and open fractures. Minerva Ortop. 36.
RECREATIONAL INJURIES
Sports injuries A survey of 1652 sporting injuries in Brisbane. Sixty-nine per cent of injuries occurred during competition; 7 per cent were due to foul play in contact sports. Smithers M. and Myers P. T. (1985) Injuries in sport. A prospective casualty study. Med. J. Aust. 142, 457.
BURNS
Use of skeletal immobilization Sixty-eight burned hands were treated using skeletal immobi-
Long-term assessment of treatment of hand burns The long-term effects of early excision and immediate autografting were assessed in 478 patients with 78 per cent hand burns. This procedure provided good to excellent functional results in more than 90 per cent of the hands when the burns were deep dermal or full-thickness skin loss. Poor results were obtained when the injuries were deeper and involved tendons, nerves, bones and joints. In patients with only superficial dermal burns non-surgical treatment with silver nitrate dressings and early physical therapy produced very good results. The authors suggest that all burned hands judged unlikely to heal within 3 weeks will benefit from early excision and grafting by experienced surgical personnel. Frist W., Ackroyd F., Burke J. F. et al. (1985) Long term functional results of selective treatment of hand burns. Am. J. Surg. 149, 516.
H A N D INJURIES High-pressure water jet injury One case is reported, affecting the thumb and little finger, with complete recovery after injection at 5000 p.s.i. Koa M. (1985) High-pressure water jet injury of the hand. J. Hand Surg. 10A, 412.
Dislocation of the proximal interphalangeal joint Eighteen cases are reported. The lesson was that these injuries require careful repair in good conditions if sepsis and even amputation are to be avoided. Stern P. J. and Lee A. F. (1985) Open dorsal dislocations of the proximal interphalangeal joint. J. Hand Surg. 10A, 364.
Metacarpal reconstruction The grafts were successfully incorporated, without visible callus and with a gradual change to the natural texture of the part, supposedly by creeping substitution, in 6-12 months. Smith R. J. and Brushart T. M. (1985) Allograft bone for metacarpal reconstruction. J. Hand Surg. 10A, 325.
Treatment of ring injuries Avulsion of fingers by rings was dealt with energetically by these surgeons. They report a series of 32 cases with details of the methods of reconstruction where feasible and about the timing and level of amputation when this was imperative. They discuss indications and results. They advocate primary microvascular surgery but delayed repair for the other elements. Codega et al. (1985) Treatment of ring injuries. Minerva Ortop. 36.