1. The mechanism of production of injury to the lateral condyle epiphysis is discussed. 2. A technique of closed reduction of rotational displacements of the epiphysis is described. Nine cases in which the method was successful are noted. 3. It is suggested that the injury should be classified with dislocation of the elbow.
We report the results in 33 patients who had nerve grafting of the axillary or the suprascapular nerve or of both. There were 32 men and one woman; their mean age was 21 years and the average interval between injury and operation was three months. At a mean follow-up of 27 months, the deltoid had recovered to M3 or better in 23 of 30 patients (77%) and the infraspinatus in 18 of 25 patients (72%). Shoulder elevation had reached 120° or more in 27 patients (82%), with external rotation of 30° or more in 27 (82%). Twenty-six patients (79%) could reach to the top of their head with their hand. Recovery of muscle strength, range of movement and shoulder function were satisfactory when surgery was performed within four months of the injury. Early exploration and nerve grafting can lead to a good functional recovery, but thorough exploration and careful repair of both nerves are essential.
1. Three cases of cement injection into the tissues of the thumb and index finger are recorded. 2. This is probably the first description of this type of injection injury. 3. Recommendations are made for the prevention of the injury.
1. Forty-two previously asymptomatic patients presenting with a recent rupture of the lateral ligament of the ankle, and twenty similar patients with a simple sprain of this ligament, have been followed for one year. The physical and radiological findings upon the completion of treatment have been related to functional instability of the foot one year later. 2. Persistent mechanical varus instability of the talus in the ankle mortise was a possible cause of functional instability one year after injury in four (or perhaps six) patients. 3. Adhesion formation was a possible cause of functional instability in one patient. 4. Seventeen patients finally displayed no clinical or radiological abnormality after injury, but noted functional instability of the foot one year later. 5. It is concluded that the pathological process which is usually responsible for functional instability of the foot after a lateral ligament injury is at present unknown.
1 . Power and precision grip (Napier 1956) were tested in 154 patients with nerve injuries. 2. The results are described, illustrated and discussed and it is suggested that these tests provide a simple, repeatable and objective method of assessing prehensile function of the hand as a whole.
1. Some of the problems of treatment of a patient with a head injury and a fractured femur are mentioned. 2. The methods of treatment and results obtained in fifty-nine such patients from the Oxford Accident Service are described.
1. Paralysis caused by anterior nerve root section, or by peripheral nerve section, leads to marked changes in the bones and muscles of the affected limb in experimental animals. Vascular changes are not the cause of the bone atrophy in a paralysed limb. 2. The altered properties of the bones of a paralysed limb are due almost entirely to a loss in the quantity of bone; bone quality is only slightly altered. 3. The bone changes that follow paralysis are due to the secondary loss of muscular activity. No evidence could be obtained that nerves exert any specific, trophic influence on bone.
After brachial plexus injuries, and other forms of paralysis of the upper limb, even when residual paralysis is very grave indeed, and even when the limb is almost flailâa forearm which can project forwards by the construction of a bone-block behind the elbow, with arthrodesis of the shoulder when necessary; a hand with fingers in the form of a claw and a thumb which opposes them; and a wrist which may perhaps be arthrodesed, but which still better can flex or extend when the forearm is pronated or supinated; together with the wise use of such muscles as are likely to gain function; may enable a patient to do very much more than he can with an artificial limb.
1) A case is reported of paraplegia with normal radiographic appearances in which cervical cord damage was shown at autopsy to have been due to hyperextension injury. 2) The mechanism of such injuries is discussed, together with the differential diagnosis from acute prolapse of an intervertebral disc. 3) The grave dangers of using the fully extended position of the cervical spine in the management of these cases is noted.
We studied 45 children who presented with an inversion injury of the ankle. The clinical signs suggested injury to the distal growth plate of the fibula, but the plain radiographs appeared normal. Ultrasound examination of the joint in 40 patients showed a subperiosteal haematoma consistent with a growth-plate injury in 23 (57.5%). Children who had been treated with a tubular bandage and crutches by random selection had a mean time to return of normal activity of 14.22 days compared with 21.60 days for those treated with a plaster-of-Paris cast (t = 3.60, p = 0.0032; d = 7.38, 95% CI 3.0 to 11.8). We conclude that children with inversion ankle injuries who have clinical signs of injury to the distal fibular growth plate but a normal radiological appearance, should be treated with a tubular bandage and crutches.
We report two cases of deformity of the ankle caused by physeal damage secondary to extravasation of an intravenous infusion in infancy. The possible mechanisms of injury to the physis are discussed.
1. The deep posterior muscles of the neck are innervated by the posterior branches of spinal nerves, which branch off immediately after the root emerges from the intervertebral foramen. Electromyographic examination of these muscles permits a differential diagnosis to be made between intraforaminal and extraforaminal brachial plexus lesions. 2. The earlier diagnosis and prognosis thus achieved permit definitive treatment, in particular suture of the torn nerve trunks in recent extraforaminal cases.
The April 2023 Children’s orthopaedics Roundup. 360. looks at: Can you treat type IIA supracondylar humerus fractures conservatively?; Bone bruising and anterior cruciate ligament injury in paediatrics; Participation and motor abilities after treatment with the Ponseti method; Does fellowship training help with paediatric supracondylar fractures?; Supracondylar elbow fracture management (Supra Man): a national trainee collaborative evaluation of practice; Magnetically controlled growing rods in early-onset scoliosis; Weightbearing restrictions and weight gain in children with Perthes’ disease?;
