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Liver packing for uncontrolled haemorrhage
294
injury (1987) 18,294-295
Printed in Great Britain
Abstracts INJURlES OF THE HEAD AND SPINE
THORACIC AND ABDOMINAL INJURIES
Gymnastics injuries In 30 years, 33 men and 5 women were treated for injuries of
Liver packing for uncontrolled
this sort; 31 were paralysed, 24 completely. Twenty-eight of the paralysing injuries were in the neck and were most often the result of landing on the head in the course of unsupervised activity in a gymnasium. Silver J. R., Silver D. D. and Godfrey J. J. (1986) Injuries of the spine sustained during gymnastic activities. Br. Med. J. 293. 861.
FRACTURES AND DISLOCATIONS Infection in extremity
Cervical disc prolapse
A complaint of numb and clumsy hands and trouble in the legs in an old person with marked cervical spondylosis may be the result of a prolapsed disc and responds well to surgical decompression. Symptoms of recent onset without obvious cause should be investigated with this in mind. Young S., Tamas L. and O’Laoire S. A. (1986) Prolapse of a cervical disc in elderly patients with cervical spondylosis. Br. Med. J. 203, 749.
Severe head injury in children
Thirty-seven children were studied; 72 per cent had Glasgow coma score of less than 8. Thirty-three per cent died but the unit concerned admitted freshly injured children. Fifty-one per cent made at least a moderately good recovery within 6 months. Diffuse swelling usually augured well, unlike raised pressure and mass lesions. Berger M. S., Pitts L. H., Lovely M. et al. (1985) Outcome from severe head injury in children and adolescents. J. ~e~ros~rg. 62, 194.
All 37 had been in coma since the injury and most were examined by CT within 12 hours of the injury. If the third ventricles and basal cisterns were open, intracranial pressure averaged 11.5 mmHg but if one or other of these spaces were closed the pressure averaged 3SmmHg. The third ventricle was occluded before there was evidence of dysfunction in the midbrain. Teasdale E., Cardoso E., Galbraith S. and Teasdale G. (1984) C.T. scan in severe, diffuse head injury; physiological and clinical correlations. J. Neurol. Neurosurg. Psychiatry 47, 600. Lumbar disc degeneration
Three hundred and two women from 16-80 years of age and without symptoms of any disorder of the spine were examined by magnetic resonance. Degeneration of intervertebral discs increased with age but one-third of women between 16 and 40 years showed degenerative changes. The influence of this on later prolapse is as yet unknown. Powell M. C., Szypryt P., Wilson M., Symonds E. M. and Worthington B. S. (1986) Prevalence of lumbar disc degeneration observed by magnetic resonance in symptomless women. Lancet ii, 1366.
fractures
A total of 280 open and 573 fractures of limbs were fixed internally. Eleven per cent of the open fractures became infected, all by ‘hospital organisms’ that were resistant to the antibiotic used; 3 per cent of originally closed fractures became infected. Antibiotics given before fixation of the closed fractures did reduce the likelihood of infection. There was no justification for giving ‘prophylactic’ antibiotics after the operation. Roth A. J., Fry D. E. and Polk 1-I. C. (1986) Infectious morbidity in extremity fractures. 1. Trauma 26, 757. Union of tibia1 fractures
Comparable groups of serious fractures of the tibia were treated by rigid external fixation. Adding small axial movements for half an hour a day accelerated union as compared with unmodified fixation. Kenwright J., Goodship A. E., Kelly D. J., Newman J. fi., Harris J. D., Richardson J. B., Evans M., Spriggins A. J., Burrough S. J. and Rowley D. J. (1986) The effect of controlled axial micromovement on healing of tibia1 fractures. Lancet ii. 1185. lntramedullary
CT scan in severe head injury
haemorrhage
Prolonged closed liver packing in severe hepatic trauma: experience with 36 patients. Ivatury R. R., Nallathambi M., Gunduz Y.. Constable R., Rahman M. and Stahl W. M. (1986) Liver packing for uncontrolled haemorrhage: a reappraisal. J. Truu~ff 26,744.
fixation of humeral fractures
Ninety-four per cent of 58 fractures united and 62 per cent yielded excellent clinical results. Rush’s and Ender’s nails driven downwards should not breach the rotator cuff. Those driven upwards should not be passed through epicondyles or the olecranon fossa. Fractures of the humerus occurring in isolation should not be operated on. Brumback R. J., Bosse M. J., Poka A. and Burgess A. R. (1986) Intramedullary stabilisation of humeral shaft fractures in patients with multiple trauma. J. Bone Joint Surg. @A, 960. Fra~ure~isl~ation
of saerum
A i7-year-old woman landed heavily in a sitting position and sustained downward displacement of the sacrum. This was treated by increasing activity and she made a full recovery. Lafollette B. F., Levine M. I. and McNeish L. M. (1986) Bilateral fracture-dislocation of the sacrum. J. Bone Joint Surg. 68A, 1099. Atlanto-occipital
dislocation
A 3-year-old boy was knocked out by a blow on the head. NO abnormality in the head and neck was recognized and there was no neurological abnormality a few days later. Two months later there was widespread weakness, most marked at the shoulders and lateral displacement of the skull on the
injury (1987) 18,294-295
Printed in Great Britain
Abstracts INJURlES OF THE HEAD AND SPINE
THORACIC AND ABDOMINAL INJURIES
Gymnastics injuries In 30 years, 33 men and 5 women were treated for injuries of
Liver packing for uncontrolled
this sort; 31 were paralysed, 24 completely. Twenty-eight of the paralysing injuries were in the neck and were most often the result of landing on the head in the course of unsupervised activity in a gymnasium. Silver J. R., Silver D. D. and Godfrey J. J. (1986) Injuries of the spine sustained during gymnastic activities. Br. Med. J. 293. 861.
FRACTURES AND DISLOCATIONS Infection in extremity
Cervical disc prolapse
A complaint of numb and clumsy hands and trouble in the legs in an old person with marked cervical spondylosis may be the result of a prolapsed disc and responds well to surgical decompression. Symptoms of recent onset without obvious cause should be investigated with this in mind. Young S., Tamas L. and O’Laoire S. A. (1986) Prolapse of a cervical disc in elderly patients with cervical spondylosis. Br. Med. J. 203, 749.
Severe head injury in children
Thirty-seven children were studied; 72 per cent had Glasgow coma score of less than 8. Thirty-three per cent died but the unit concerned admitted freshly injured children. Fifty-one per cent made at least a moderately good recovery within 6 months. Diffuse swelling usually augured well, unlike raised pressure and mass lesions. Berger M. S., Pitts L. H., Lovely M. et al. (1985) Outcome from severe head injury in children and adolescents. J. ~e~ros~rg. 62, 194.
All 37 had been in coma since the injury and most were examined by CT within 12 hours of the injury. If the third ventricles and basal cisterns were open, intracranial pressure averaged 11.5 mmHg but if one or other of these spaces were closed the pressure averaged 3SmmHg. The third ventricle was occluded before there was evidence of dysfunction in the midbrain. Teasdale E., Cardoso E., Galbraith S. and Teasdale G. (1984) C.T. scan in severe, diffuse head injury; physiological and clinical correlations. J. Neurol. Neurosurg. Psychiatry 47, 600. Lumbar disc degeneration
Three hundred and two women from 16-80 years of age and without symptoms of any disorder of the spine were examined by magnetic resonance. Degeneration of intervertebral discs increased with age but one-third of women between 16 and 40 years showed degenerative changes. The influence of this on later prolapse is as yet unknown. Powell M. C., Szypryt P., Wilson M., Symonds E. M. and Worthington B. S. (1986) Prevalence of lumbar disc degeneration observed by magnetic resonance in symptomless women. Lancet ii, 1366.
fractures
A total of 280 open and 573 fractures of limbs were fixed internally. Eleven per cent of the open fractures became infected, all by ‘hospital organisms’ that were resistant to the antibiotic used; 3 per cent of originally closed fractures became infected. Antibiotics given before fixation of the closed fractures did reduce the likelihood of infection. There was no justification for giving ‘prophylactic’ antibiotics after the operation. Roth A. J., Fry D. E. and Polk 1-I. C. (1986) Infectious morbidity in extremity fractures. 1. Trauma 26, 757. Union of tibia1 fractures
Comparable groups of serious fractures of the tibia were treated by rigid external fixation. Adding small axial movements for half an hour a day accelerated union as compared with unmodified fixation. Kenwright J., Goodship A. E., Kelly D. J., Newman J. fi., Harris J. D., Richardson J. B., Evans M., Spriggins A. J., Burrough S. J. and Rowley D. J. (1986) The effect of controlled axial micromovement on healing of tibia1 fractures. Lancet ii. 1185. lntramedullary
CT scan in severe head injury
haemorrhage
Prolonged closed liver packing in severe hepatic trauma: experience with 36 patients. Ivatury R. R., Nallathambi M., Gunduz Y.. Constable R., Rahman M. and Stahl W. M. (1986) Liver packing for uncontrolled haemorrhage: a reappraisal. J. Truu~ff 26,744.
fixation of humeral fractures
Ninety-four per cent of 58 fractures united and 62 per cent yielded excellent clinical results. Rush’s and Ender’s nails driven downwards should not breach the rotator cuff. Those driven upwards should not be passed through epicondyles or the olecranon fossa. Fractures of the humerus occurring in isolation should not be operated on. Brumback R. J., Bosse M. J., Poka A. and Burgess A. R. (1986) Intramedullary stabilisation of humeral shaft fractures in patients with multiple trauma. J. Bone Joint Surg. @A, 960. Fra~ure~isl~ation
of saerum
A i7-year-old woman landed heavily in a sitting position and sustained downward displacement of the sacrum. This was treated by increasing activity and she made a full recovery. Lafollette B. F., Levine M. I. and McNeish L. M. (1986) Bilateral fracture-dislocation of the sacrum. J. Bone Joint Surg. 68A, 1099. Atlanto-occipital
dislocation
A 3-year-old boy was knocked out by a blow on the head. NO abnormality in the head and neck was recognized and there was no neurological abnormality a few days later. Two months later there was widespread weakness, most marked at the shoulders and lateral displacement of the skull on the