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Repair of acromioclavicular dislocation
Volume 3 Number 3
175
ACCIDENT SERVICES TODAY
surgeons and all the resources of the hospital. As well as the accident work, they will decide about emergency surgical admissions to the surgical wards. On the days when they are not working in the casualty department, these surgeons will work in the accident wards. They will have their own specialty-orthopaedics, hand surgery, neurosurgery, or abdominal and general surgerybut as well as dealing with cases in their own specialty, they will act under the overall direction of the senior orthopaedic consultant (who is to be director of the accident service) as co-ordinators in all cases of accidents where more than Requests
for reprintsshould
be addressed to:-W.
in the not too distant
H. Rutherford,
ABSTRACTS
FRACTURES
one discipline may be involved. They will also be given time for study, research, and teaching, so that the full benefits of knowledge and experience may be passed on to the surgeons of tomorrow. We also hope to have a consultant physician appointed as physician to the casualty department, the intensive care, and accident wards. Formulating these plans has not been easy, but we now feel we have a conception of the future which is winning the support of all our surgical colleagues, and looks likely to be accepted by the Northern Ireland Hospitals Authority
AND DISLOCATIONS
Internal Fixation of Femoral Neck Fractures By ‘ conservative treatment’ these authors mean ‘internal fixation’ as opposed to primary replacement of the femoral head. not as one mieht have thought by traction methods without surgery. The authors describe a method of internally fixing subcapital femoral neck fractures using nails and screws, or nails, plates, and screws in combination. They have treated a series of 72 patients whose ages ranged from 55 to 92 with the usual sex distribution for this condition. They use Pauwel’s system of classification of the grades of fracture. They
routinely operate on them urgently and always within 24 hours. They make a point of obtaining a really exact reduction of the fracture under general anaesthetic with X-ray control. They start off by drilling in three Kirschne; wires in different plan& from the subtrochanteric region of the femur through the neck, head and right :into the acetabuhun to hold the position tidy during the subsequent manceuvres. They aim to get both the nail and the screw in the low-angle position, getting a grip on the posterosuperior quadram of the femoral head. The screw or screws are inserted so as to lie roughly parallel to the nail but above it. The screws are inserted lag-wise as they have smooth shanks and broad cancellous threads. If there is doubt about the firmness of the outer cortex they obtain a good purchase at the outer end of the nail with a plate which is applied simultaneously and fixed to the nail with a bolt. Postoperatively the patient has no traction but starts active movements on the second day, sitting with the legs over the edge of the bed. Crutch walking began soon and they were walking with sticks between the
future.
Esq., F.R.C.S., The Royal
Victoria Hospital, Belfast.
twentieth and thirtieth day. Postoperative radiographs were taken monthly for the first four months. The results were assessed between 1 and 7 years and were classed as excellent in 58 of the 72 cases, moderate in 10 cases, and failures in 4 cases, the latter being reviewed between 1 month and 1 year after the operation. They got good results in 80 per cent of cases treated in this manner, concluding that a nail in combination with screws gets an improved fixation and a better reduction of the fracture. there being an element of
compression added to this. They ibelieve that an intensive period of physiotherapy for 3 months is necessary to secure these good results. BARBIERI.E.. and CHIUMENTI.G. C. (1971). ’ On the ConservatiGe yreatment of Sibcapitzd Fractures of the Femoral Neck ’ [Italian], Minerva ortoped., 22, 309. Repair of Acromioclavicular Dislocation Dr. Ahstrom from Chicago reports on 15 patients whose acromioclavicular dislocations were repaired by open reduction with a procedure originally described by Vargas. The joint is approached through the deltopectoral interval and a heavy threaded wire is drilled through the acromion to present at the centre of the articular surface. The dislocation is then reduced and the wire inserted into the outer 2 in. of the clavicle. The lateral part of the wire is cut to lie in the subcutaneous tissue. The capsule is then repaired and a segment of the short head of the biceps is turned UDand sutured to the clavicle. Gentlemovement is encouiaged after a few days and the pin is removed after 6-8 weeks. Seven of the 15 cases were followed for less than 1 year. There was 1 poor result because of infection, 1 fair result, and 13 were good. None of these reported cases was followed l&g enough to rule out the possible complication of arthrosis which is one of the main reasons for the much more popular operation of excision of the outer end of the clavicle. AHSTROM,J. P. (1971), ‘Surgical Repair of Complete Acromioclavicular Separation ‘, J. Am. med. Ass., 217, 785.
175
ACCIDENT SERVICES TODAY
surgeons and all the resources of the hospital. As well as the accident work, they will decide about emergency surgical admissions to the surgical wards. On the days when they are not working in the casualty department, these surgeons will work in the accident wards. They will have their own specialty-orthopaedics, hand surgery, neurosurgery, or abdominal and general surgerybut as well as dealing with cases in their own specialty, they will act under the overall direction of the senior orthopaedic consultant (who is to be director of the accident service) as co-ordinators in all cases of accidents where more than Requests
for reprintsshould
be addressed to:-W.
in the not too distant
H. Rutherford,
ABSTRACTS
FRACTURES
one discipline may be involved. They will also be given time for study, research, and teaching, so that the full benefits of knowledge and experience may be passed on to the surgeons of tomorrow. We also hope to have a consultant physician appointed as physician to the casualty department, the intensive care, and accident wards. Formulating these plans has not been easy, but we now feel we have a conception of the future which is winning the support of all our surgical colleagues, and looks likely to be accepted by the Northern Ireland Hospitals Authority
AND DISLOCATIONS
Internal Fixation of Femoral Neck Fractures By ‘ conservative treatment’ these authors mean ‘internal fixation’ as opposed to primary replacement of the femoral head. not as one mieht have thought by traction methods without surgery. The authors describe a method of internally fixing subcapital femoral neck fractures using nails and screws, or nails, plates, and screws in combination. They have treated a series of 72 patients whose ages ranged from 55 to 92 with the usual sex distribution for this condition. They use Pauwel’s system of classification of the grades of fracture. They
routinely operate on them urgently and always within 24 hours. They make a point of obtaining a really exact reduction of the fracture under general anaesthetic with X-ray control. They start off by drilling in three Kirschne; wires in different plan& from the subtrochanteric region of the femur through the neck, head and right :into the acetabuhun to hold the position tidy during the subsequent manceuvres. They aim to get both the nail and the screw in the low-angle position, getting a grip on the posterosuperior quadram of the femoral head. The screw or screws are inserted so as to lie roughly parallel to the nail but above it. The screws are inserted lag-wise as they have smooth shanks and broad cancellous threads. If there is doubt about the firmness of the outer cortex they obtain a good purchase at the outer end of the nail with a plate which is applied simultaneously and fixed to the nail with a bolt. Postoperatively the patient has no traction but starts active movements on the second day, sitting with the legs over the edge of the bed. Crutch walking began soon and they were walking with sticks between the
future.
Esq., F.R.C.S., The Royal
Victoria Hospital, Belfast.
twentieth and thirtieth day. Postoperative radiographs were taken monthly for the first four months. The results were assessed between 1 and 7 years and were classed as excellent in 58 of the 72 cases, moderate in 10 cases, and failures in 4 cases, the latter being reviewed between 1 month and 1 year after the operation. They got good results in 80 per cent of cases treated in this manner, concluding that a nail in combination with screws gets an improved fixation and a better reduction of the fracture. there being an element of
compression added to this. They ibelieve that an intensive period of physiotherapy for 3 months is necessary to secure these good results. BARBIERI.E.. and CHIUMENTI.G. C. (1971). ’ On the ConservatiGe yreatment of Sibcapitzd Fractures of the Femoral Neck ’ [Italian], Minerva ortoped., 22, 309. Repair of Acromioclavicular Dislocation Dr. Ahstrom from Chicago reports on 15 patients whose acromioclavicular dislocations were repaired by open reduction with a procedure originally described by Vargas. The joint is approached through the deltopectoral interval and a heavy threaded wire is drilled through the acromion to present at the centre of the articular surface. The dislocation is then reduced and the wire inserted into the outer 2 in. of the clavicle. The lateral part of the wire is cut to lie in the subcutaneous tissue. The capsule is then repaired and a segment of the short head of the biceps is turned UDand sutured to the clavicle. Gentlemovement is encouiaged after a few days and the pin is removed after 6-8 weeks. Seven of the 15 cases were followed for less than 1 year. There was 1 poor result because of infection, 1 fair result, and 13 were good. None of these reported cases was followed l&g enough to rule out the possible complication of arthrosis which is one of the main reasons for the much more popular operation of excision of the outer end of the clavicle. AHSTROM,J. P. (1971), ‘Surgical Repair of Complete Acromioclavicular Separation ‘, J. Am. med. Ass., 217, 785.