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The Bone & Joint Journal
Vol. 105-B, Issue 4 | Pages 347 - 355
15 Mar 2023
Birch NC Cheung JPY Takenaka S El Masri WS

Initial treatment of traumatic spinal cord injury remains as controversial in 2023 as it was in the early 19th century, when Sir Astley Cooper and Sir Charles Bell debated the merits or otherwise of surgery to relieve cord compression. There has been a lack of high-class evidence for early surgery, despite which expeditious intervention has become the surgical norm. This evidence deficit has been progressively addressed in the last decade and more modern statistical methods have been used to clarify some of the issues, which is demonstrated by the results of the SCI-POEM trial. However, there has never been a properly conducted trial of surgery versus active conservative care. As a result, it is still not known whether early surgery or active physiological management of the unstable injured spinal cord offers the better chance for recovery. Surgeons who care for patients with traumatic spinal cord injuries in the acute setting should be aware of the arguments on all sides of the debate, a summary of which this annotation presents.

Cite this article: Bone Joint J 2023;105-B(4):347–355.


The Journal of Bone & Joint Surgery British Volume
Vol. 92-B, Issue 12 | Pages 1632 - 1635
1 Dec 2010
Hindle P

This paper outlines the history of advances made in the treatment of open fractures that have occurred during wartime.


The Journal of Bone & Joint Surgery British Volume
Vol. 90-B, Issue 10 | Pages 1276 - 1277
1 Oct 2008
Birch R

John Kirkup, the distinguished orthopaedic surgeon and archivist recently published a book describing the history of amputation. This annotation highlights the importance of this work and the particular relevance of many of its themes to current orthopaedic and trauma practice.


The Journal of Bone & Joint Surgery British Volume
Vol. 89-B, Issue 10 | Pages 1280 - 1282
1 Oct 2007
Klenerman L

This paper describes how we came to understand the pathophysiology of Volkmann’s ischaemic contracture with references to relevant papers in this Journal, and the investigation and management of acute compartment syndrome is briefly discussed.


The Journal of Bone & Joint Surgery British Volume
Vol. 89-B, Issue 5 | Pages 580 - 585
1 May 2007
Crowley DJ Kanakaris NK Giannoudis PV

Modern principles for the treatment of open fractures include stabilisation of the bone and management of the soft tissues. Wound debridement and irrigation is thought to be the mainstay in reducing the incidence of infection. Although numerous studies on animals and humans have focused on the type of irrigation performed, little is known of the factors which influence irrigation. This paper evaluates the evidence, particularly with regard to additives and the mode of delivery of irrigation fluid.

Normal saline should be used and although many antiseptics and antibiotics have been employed, no consensus has been reached as to the ideal additive. Despite the advocates of high-pressure methods highlighting the improved dilutional ability of such techniques, the results are inconclusive and these irrigation systems are not without complications.

New systems for debridement are currently being investigated, and an ideal method has yet to be determined.


The Journal of Bone & Joint Surgery British Volume
Vol. 87-B, Issue 6 | Pages 759 - 761
1 Jun 2005
Calder J Mannion S


The Journal of Bone & Joint Surgery British Volume
Vol. 87-B, Issue 4 | Pages 450 - 453
1 Apr 2005
Reis ND Better OS