The diagnosis of nerve injury using thermotropic liquid crystal temperature strips was compared blindly and prospectively against operative findings in 36 patients requiring surgical exploration for unilateral upper limb lacerations with suspected nerve injury. Thermotropic liquid crystal strips were applied to affected and non-affected segments in both hands in all subjects. A pilot study showed that a simple unilateral laceration without nerve injury results in a cutaneous temperature difference between limbs, but not within each limb. Thus, for detection of a nerve injury, comparison was made against the unaffected nerve distribution in the same hand. Receiver operating characteristic curve analysis showed that an absolute temperature difference ≥ 1.0°C was diagnostic of a nerve injury (area under the curve = 0.985, sensitivity = 100%, specificity = 93.8%). Thermotropic liquid crystal strip assessment is a new, reliable and objective method for the diagnosis of traumatic peripheral nerve injuries. If implemented in the acute setting, it could improve the reliability of clinical assessment and reduce the number of negative surgical explorations.
The use of volar locking compression plates for the treatment of fractures of the distal radius is becoming increasingly popular because of the stable biomechanical construct, less soft-tissue disturbance and early mobilisation of the wrist. A few studies have reported complications such as rupture of flexor tendons. We describe three cases of rupture of extensor tendons after the use of volar locking compression plates. We recommend extreme care when drilling and placing the distal radial screws to prevent damaging the extensor tendons.
This study aimed to ascertain the effect of operative delay on mortality of patients with hip fractures excluding those delayed for medical reasons. In our unit, patients with hip fractures (fractures of the femoral neck and trochanteric zone) have surgery on trauma operating lists shared with plastic surgery emergencies. They are not specifically prioritised and are operated on in order of admission. In a 6-month period, 221 consecutive patients over the age of 65 were planned for surgical treatment of their hip fracture in our unit. 16 patients had surgery delayed for medical reasons and were excluded from further analysis. In a further 9 patients it was not possible to confirm the exact delay to theatre from records and these were also excluded. This left 196 patients in whom it was possible to relate in-hospital and 90-day mortality to surgical delay. These data demonstrate a significant trend towards increasing mortality with increasing delay (χ2-test for trend: p = 0. 0015 (in-hospital) and p = 0. 0021 (90-day)). Comparison of mortality between those delayed 2 days or less (164 patients) and those delayed more than 2 days (32 patients) was also highly significant (Fisher’s exact test: p = 0. 0008 (in-hospital) and p = 0. 0004 (90-day)). We conclude that delays to surgery in patients with hip fractures, particularly beyond 2 calendar days, result in unacceptably high mortality. Practice should be modified to ensure these patients receive greater priority for theatre time.
We have reviewed the incidence of bacteriologically or radiologically confirmed acute haematogenous osteomyelitis in children under 13 years of age resident in the area of the Greater Glasgow Health Board between 1990 and 1997. In this period there was a fall of 44% in the incidence of both acute and subacute osteomyelitis, mainly involving the acute form (p = 0.005). This mirrors the decline of just over 50% previously reported in the same population between 1970 and 1990. Using multiple regression analysis a decline in incidence of 0.185 cases per 100 000 population per year was calculated for the 28-year period (p >
0.001).
Haematogenous osteomyelitis in children in this area is becoming a rare disease with an annual incidence of 2.9 new cases per 100 000 population per year.
