1. The success of any method of treating the injured hand is to be measured by the use that is made of the remnant. 2. Careful, prompt surgical treatment of the wound will usually allow prompt healing. 3. Skin-grafts, internal fixation of fractures and the eking out and rearrangement of tissues that have escaped injury have an important place in primary treatment. 4. Many hands so treated are ready for use after one operation and within a few weeks of being injured. 5. Reconstruction in several stages should not be carried out unless it offers a reasonable prospect of improvement that will be useful to the particular patient.
1. A method of treatment of the congenitally dislocated hip is described. 2. The rationale of the treatment is considered. 3. The subsequent development of the hip generally, and of its individual components, is described. 4. Comparison between the results of other methods of treatment and of this method is not attempted for reasons stated. 5. The advantages of a shortened period of splintage are discussed. 6. The state of fifty completely dislocated hips treated consecutively is described at the end of a follow-up period of from three to seven and a half years.
The use of the upright position of the patient, and a vertical incision for exposure of the brachial plexus, has been attended by no complications or serious hazards. The aid of skilled anaesthetists is acknowledged. The structures are visible and accessible; the operative field is steady; bleeding is controlled easily; and dissection is facilitated. By this technique it has been possible to explore a larger field from above, and division of the clavicle has seldom been necessary. Finally, and of importance, the operative area at shoulder level enables the surgeon to continue tedious dissection for some hours comfortably, and to escape postoperative postural complications in his own back.
1. It is suggested that slow recovery and post-operative effusion after meniscectomy may often be due to "scar friction" when the incision in the synovial membrane is in contact with the non-articular surface of the femoral condyle. 2. The advantages of a horizontal incision are discussed, particularly with regard to early recovery. 3. The results of one hundred and three cases of meniscectomy are analysed. An attempt to trace the cause of incompletely successful results in 25 per cent. of cases failed to show any relation to minor coincident lesions discovered at operation, or to the amount of meniscus removed.
A method is described which provides standardised reproducible radiographic images of the lower limb. Anteroposterior and lateral radiographs are digitised and processed by computer to provide graphic/numeric displays of angles and linear measurements, relating the centre points of the hip, knee, and ankle. Two cases illustrate how surgical planning is facilitated when standardised data are available. These data confirm the close relationship between postoperative limb alignment and positioning of prosthetic elements.
We compared the success of the screening programmes for congenital dislocation of the hip in two hospitals in the same district, as applied to 68,861 live births over 11 years. Both used only clinical tests on new-born infants. Screening was less successful when the tests were done by junior paediatric physicians than by senior physiotherapists supervised by an orthopaedic surgeon. Clinical screening can be highly effective provided that all babies are screened at birth, and high-risk cases are followed up by a properly trained team with a well-designed protocol.
We describe the use of Ender nails for the internal fixation of femoral shaft fractures by a closed technique via the greater trochanter and report the treatment of 100 patients with 106 fractures, of which 88 were reviewed 12 months or more after operation. There was primary union in 85 fractures (96.6%) and significant angulation, rotation or leg length discrepancy in eight (9%). We discuss the principles of management which we have evolved.
Lateral instability of the patella was found after recurrent, habitual and permanent dislocations. Contracture of soft tissues lateral to the patella only occurred with habitual and permanent dislocations, but medial laxity was present in all cases. After adequate release of the lateral contracture, the medial stability was improved by transposition of the lower three-quarters of the pes anserinus to the medial border of the patella, and the patellar ligament. This created a relatively unstretchable physiological sling which ensured dynamic stability of the patella. Six recurrent, 21 habitual and nine permanent dislocations of the patella were treated by this method. Results were excellent in 21 patients, good in 13 and fair in two. The follow-up period varied from 21 to 84 months. There have been no recurrences to date.
Aims. Patients with femoral neck fractures (FNFs) treated with total hip arthroplasty (THA) have an almost ten-fold increased risk of dislocation compared to patients undergoing elective THA. The surgical approach influences the risk of dislocation. To date, the influence of differing head sizes and dual-mobility components (DMCs) on the risk of dislocation has not been well studied. Methods. In an observational cohort study on 8,031 FNF patients with THA between January 2005 and December 2014, Swedish Arthroplasty Register data were linked with the National Patient Register, recording the total dislocation rates at one year and revision rates at three years after surgery. The cumulative incidence of events was estimated using the Kaplan-Meier method. Cox multivariable regression models were fitted to calculate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for the risk of dislocation, revision, or mortality, stratified by surgical approach. Results. The cumulative dislocation rate at one year was 8.3% (95% CI 7.3 to 9.3) for patients operated on using the posterior
