Introduction. Compartment syndrome can be a life changing consequence of injury to a limb. If not diagnosed and treated early it can lead to permanent disability. Neurovascular observations done on the ward by nursing staff, are often our early warning system to those developing compartment syndrome. But are these adequate for detecting the early signs of compartment syndrome? Our aim was to compare the quality and variability of charts across the UK major trauma network. Materials & Methods. All major trauma centres in England and Scotland were invited to supply a copy of the neurovascular chart routinely used. We assessed how such charts record relevant information. Specific primary data points included were pain scores, analgesia requirements, pain on passive stretch and decreased sensation in the first web space specifically. As secondary objectives, we assessed how late signs were recorded, whether clear instructions were included, quantitative scores and the use of regional blocks recorded. Results. A response rate of 46% was achieved. Of the charts reviewed, 25% documented pain scores or pain on passive movement. Pain on movement and analgesia requirements were documented in 33% and 8% respectively. Specific sensation within the 1. st. webspace was recorded in 16%. No charts recorded use of regional block. All charts recorded global sensation, movement (unspecified), pulse and colour whilst 66% documented capillary refill and 83% temperature. Instructions were included in 41% of charts. Conclusions. In 2016, the BOA supported publication of an observation chart for this purpose however, it is not widely used. In our study, late signs of compartment syndrome were generally well recorded. However, documentation of early signs and regional blocks was poor. This may lead to delays in diagnosis with significant clinical and medicolegal consequences. Standardisation of documentation by updating and promoting the use of the pre-existing chart would ensure highest quality care across the network

Introduction and Aims: Many surgical techniques are available for thumb reconstruction. These include deepening of the first web, flaps, osteoplastic reconstructions, toe to thumb transfer, pollicisation and metacarpal lengthening. The aim of this study is to assess the outcome following use of distraction methods for thumb lengthening. Method: Nineteen patients who underwent thumb metacarpal lengthening over a six-year period have been reviewed retrospectively. Lengthening was performed for terminal deficiency in 12 cases and for segmental bone loss in seven cases. The callotasis method was used in 11 patients and the Matev method in eight. The Orthofix mini-external fixator was used as the distracting device in all cases. Results: Final gains in length achieved measured from 22mm to 41mm, with an average fixator application time of 86 days (range 58 to 125). Complications included two malunions, one overlengthening, four pin migrations through bone and six cases of pin track sepsis. There were no skin or neurovascular complications. Narrowing of the first web space has been found to be a significant problem associated with thumb metacarpal lengthening in this study. This necessitated subsequent deepening of the web space in 14 patients with adductor release in seven patients. Conclusion: Distraction methods for thumb reconstruction are relatively easy, safe and do not require special facilities or prolonged theatre time. Where indicated, these techniques provide a useful alternative to other methods of thumb reconstruction

Jimmy Craig had many talents and virtues. A keen sportsman, he played rugby for his school and university and in his younger days was an amateur boxer of note. Directly from medical school he joined the Medical Corps of the South African Forces fighting in the Western desert, and then went up the boot of Italy. On his return to Johannesburg, his home town, he developed expertise in cerebral palsy treatment and surgery. From about 1970 until the year before his death in 1992, he regularly visited Ikhwezi Lokusa School for the Orthopaedically Handicapped, just outside Umtata, once or twice a year. His visits lasted a week at a time. In those years he assessed approximately 1 500 children and operated on about 600. For the first 15 years, the operations were almost exclusively soft tissue surgery: tendon lengthening, tendon transfers and clubfoot releases. As the facilities in Umtata were upgraded, he performed an increasing amount of bone surgery. The operations he did were mainly on the lower limbs. They included lengthening of the triceps surae at the level of the gastrocnemius, lengthening of the tendo Achillis, release of hamstrings and hip adductors, recession of iliopsoas recession at the hips and Souter slides. On the upper limbs he fairly regularly performed surgical release of the first web space and release of flexor carpi ulnaris. He closely supervised the postoperative care provided by the school, which always had at least one expert Bobarth trained physiotherapist in residence

Reconstruction of large composite tissue defects with expose tendons, neurovascular structures, joints and bones is difficult and challenging problem. Such difficult situations can be handled in a single stage with free tissue transfer provided microsurgical expertise is available. A review of 12 cases of free scapular flap is being presented, performed over period of 20 months from December 97 to July 1999. Free scapular flap is based on transverse branch of circumflex scapular artery, which is branch of subscapular artery. All the patients in this series were male, with average age of 29 years. The mechanism of injury leading to tissue defects was, RTA 7 cases, industrial accidents 3 cases and bomb blast injury 2 cases. The various sites requiring free scapular flaps were, plantar aspect of foot, heel and leg in 5 cases, dorsum of hand, first web space and forearm in 3 cases, axilla and upper arm in 2 cases and one each for popliteal fossa and dorsum of foot. Only 4 cases presented to AKUH within 6 hours of injury while remaining 8 cases had prior treatment somewhere else and subsequent polymicrobial infection. In three cases, 2-3 debridements were done before coverage with free flap. Average defect size was 18cm long and 11cm wide. All of these cases had associated fracture. Free scapular flap is very robust flap with long vascular pedicle and large lumen artery, which can be anastomosed very easily. Donor site is closed primarily without any morbidity and scar is hidden. Scapular flap can be considered as workhorse for extremity defects