1. Five patients with seven fatigue fractures of the lower third of the tibia are described; two had bilateral fractures. There is a striking similarity in the site and appearance of these fractures. 2. All occurred in middle-aged or elderly people without a history of unusual activity or illness. 3. The fractures are so nearly identical as to constitute an entity which, as far as we are aware, has not been described before.
1. Reduction of supracondylar fractures in children by lateral rotation of the arm combined with mechanical traction and manipulations is described. Fixation in a plaster shoulder spica is recommended. 2. The results are presented and seem to be satisfactory.
1. Ninety-eight cases of fracture of the upper end of the tibia treated by operative reduction have been reviewed. 2. The true split fractures and the mildly comminuted compression fractures showed the best results. The "mosaic" cases showed the least satisfactory results. 3. Age has scarcely any effect on the end-results and is consequently no contra-indication to operation. 4. Nearly half the patients regained normal or almost normal mobility in the knee joint. 5. In no case did a meniscus left in place cause symptoms indicating internal derangement.
1. Full recovery after fracture of the head of the radius in children may be expected in cases with tilting of the radial head from 30 to 60 degrees, whether treated by early manipulative or by operative reduction. 2. Manipulative reduction is facilitated by knowledge of the direction of displacement and tilting of the radial head, which can be determined by the study of appropriate radiographs. 3. When the upper radial epiphysis is completely displaced from the shaft, some permanent loss of movement is to be anticipated even when accurate reduction has been secured by operation. Early fusion and some deformity of the radial head are also to be expected. This is not surprising in view of the risk to the blood supply of the displaced head, particularly in those cases treated by operative reduction.
1. Trochanteric fractures are classified, with special emphasis on the stability or instability of the fracture. The importance of the cortical buttress of bone on the inner side of the femoral neck and shaft is stressed. 2. Three series of cases are presented: a) one hundred and one cases treated conservatively in hospital; b) twenty-five cases sent home by reason of lack of hospital beds; c) twenty-two cases treated by fixation with a Capener-Neufeld nail-plate. 3. From consideration of these three series, and from study of similar series of cases reported in the literature, it is suggested that routine operative treatment of trochanteric fractures has the advantages of greater comfort and mobility of the patient, lowered mortality, and economy of hospital beds. 4. Certain features of the operation of internal fixation by the Capener-Neufeld nail-plate are discussed. A director, for more efficient insertion of the nail-plate, is described. 5. The importance of early mobility after operation is emphasized. Only a small proportion of Patients can be allowed early weight-bearing but almost all can be got up in a chair, and most can be taught to get about with crutches, without weight-bearing on the fractured limb, within a few days of operation.
1. Various types of fracture of the femoral neck represent different stages of one and the same displacing movement. 2. The displacement first produces an "abduction fracture" and terminates in an "adduction fracture," passing through the stage of an " intermediary fracture" which is less well recognised. 3. These three types of fracture occur in response to the same injury and they differ only in the degree of displacement. 4. It is a mistake to believe that in " adduction fractures" the femoral head lies medially to the collum : it lies posteriorly. 5. "Impaction" is no more than the first stage of displacement of fractures in which there is limited displacement, with contact still maintained between the fragments. 6. An "impacted fracture" is not necessarily stableâif there is additional strain it may progress to the next stage of a displaced and unstable fracture. 7. These principles apply not only to fractures of the femoral neck but to all other fractures at the ends of long bones.
Splitting fractures of the humeral head are rare; part of the humeral head dislocates and the unfractured part remains attached to the shaft. We report eight cases in young patients. In five the diagnosis was made at presentation: three had minimal internal fixation using a superior subacromial approach, one had a closed reduction and one a primary prosthetic replacement. All five patients regained excellent function with no avascular necrosis at two years. In three the injury was initially unrecognised; two developed a painless bony ankylosis and one is awaiting hemiarthroplasty. It is important to obtain the three trauma radiographic views to diagnose these unusual fractures reliably. CT delineates the configuration of the fracture. In young patients open reduction and internal fixation seems preferable to replacement of the humeral head, since we have shown that the head is potentially viable.
We classified fractures of the base of the middle phalanx into five types: 1) single palmar fragment; 2) single dorsal fragment; 3) two main fragments; 4) not involving the articular surface, including epiphyseal separation in children; and 5) all others. Types 1 and 2 were subclassified into avulsion, split and split-depression. Surgery is recommended for unstable type-1 avulsion fractures, type-2 avulsions which may develop buttonhole deformities, and all fractures which displace articular cartilage surfaces. Long-term follow-up showed that surgical treatment which produced good stability and congruity gave good results. These should be the primary aims of treatment.
We reviewed 36 consecutive patients with Monteggia fracture-dislocations of the forearm; 28 had been treated within 24 hours and 8 had been referred a week or more after the initial injury with persisting or recurrent dislocation of the proximal radio-ulnar joint after treatment elsewhere. We treated 15 of the 16 complete fractures and 3 of the 11 incomplete fractures of the ulna by operative fixation. All the early fractures and six of the eight late referrals had good or excellent results. The two poor results were in patients with malalignment and dislocation of the radial head persisting for at least two weeks before definitive treatment. A good outcome after a Monteggia injury in a child requires early diagnosis and prompt, stable, anatomical reduction of the ulnar fracture. In our experience, selective operative fixation of unstable fractures provides reliable reduction and causes few complications.
We reviewed the records of 431 patients who had open reduction and internal fixation of the scaphoid performed by one surgeon (TJH) over a 13-year period. The Herbert bone screw provided adequate internal fixation without the use of plaster immobilisation, promoting a rapid functional recovery. On average, patients returned to work 4.7 weeks after surgery and wrist function was significantly improved, even when the fracture failed to unite. Healing rates for acute fractures were better than those reported for plaster immobilisation and were independent of fracture location. In the case of established nonunions, healing depended on the stage and location of the fracture, but the progress of arthritis was halted and carpal collapse significantly improved. Internal fixation of the scaphoid using the Herbert bone screw, although technically demanding, has few complications and appears to offer significant advantages over other methods of treatment.
We performed a prospective, randomised trial on 120 patients with redisplaced fractures of the distal radius comparing four methods of treatment. The four treatment groups, each containing 30 patients, were remanipulation and plaster, open reduction and bone grafting, and closed external fixation with and without mobilisation of the wrist at three weeks. The radiological results showed improvement in angulation of the distal radius for the open reduction and bone grafting group. Functional results at six weeks, three and six months and at one year, however, showed no difference between any of the four groups. The main influence on final outcome was carpal malalignment which had a statistically significant negative effect on function.
Objectives. Bone fracture healing is regulated by a series of complex physicochemical and biochemical processes. One of these processes is bone mineralization, which is vital for normal bone development. Phosphatase, orphan 1 (PHOSPHO1), a skeletal tissue-specific phosphatase, has been shown to be involved in the mineralization of the extracellular matrix and to maintain the structural integrity of bone. In this study, we examined how PHOSPHO1 deficiency might affect the healing and quality of fracture callus in mice. Methods. Tibial fractures were created and then stabilized in control wild-type (WT) and Phospho1. -/-. mice (n = 16 for each group; mixed gender, each group carrying equal number of male and female mice) at eight weeks of age.
