1. A case, believed to be the fifth on record, of supracondylar fracture with rupture of the brachial artery is described. 2. The relative immunity of the median nerve in these injuries is discussed, with brief reference to a recent case of complete rupture. Only a single previous report of this complication could be found. 3. It is suggested that these injuries are less uncommon than the number reported would indicate. 4. The anatomy of severe displacement is discussed, with special reference to the role of the brachialis. 5. The danger of closed reduction when the relationship of the upper fragment to the neurovascular bundle is in doubt is stressed. 6. The indications for open reduction are given

We studied 27 patients with low back pain and unilateral L5 or S1 spinal nerve root pain. Significant radiological changes were restricted to the symptomatic root level, when compared with controls. Low back and leg pain were graded on a visual analogue scale. Dermatomal quantitative sensory tests revealed significant elevations of warm, cool and touch perception thresholds in the affected dermatome, compared with controls. These elevations correlated with root pain (warm v L5 root pain; r = 0.88, p < 0.0001), but not with back pain. Low back pain correlated with restriction of anteroposterior spinal flexion (p = 0.02), but not with leg pain. A subset of 16 patients underwent decompressive surgery with improvement of pain scores, sensory thresholds and spinal mobility. A further 14 patients with back pain, multilevel nerve root symptoms and radiological changes were also studied. The only correlation found was of low back pain with spinal movement (p < 0.002). We conclude that, in patients with single level disease, dermatomal sensory threshold elevation and restriction of spinal movement are independent correlates of sciatica and low back pain

An experimental model was established to investigate the possibility of repairing cervical nerve roots damaged above the dorsal root ganglion, as occurs in traction injuries of the brachial plexus. In four sheep the C6 root was divided and repaired within the dura using freeze-thawed muscle grafts. Recovery was assessed after eight months by electrophysiology and histology. Action potentials were recorded distal to the grafts in all four sheep, indicating regeneration of motor fibres. Histological examination showed regenerated fibres in the ventral roots below the grafts in all cases. These fibres could be traced distally to the brachial plexus. There was no evidence of recovery of dorsal roots

We performed intercostal nerve transfer in 19 patients to relieve pain from preganglionic injury to the brachial plexus. The procedure was successful in 16 patients at a mean of 28.6 months (12 to 68) after the injury

In 15 patients who underwent open exploration of the brachial plexus, the somatosensory evoked potentials and nerve action potentials recorded at the time of operation were useful as guides to the most appropriate surgical procedure, and also in predicting the outcome in certain lesions. In three patients the apparent normality of the upper trunk of the plexus was concealing a more proximal lesion which was irrecoverable. The presence of a somatosensory evoked potential showed functional continuity in three patients in whom the C7 root was clinically involved and who recovered after operation. In five patients proximal stumps of ruptured C5 roots showed functional central continuity; this indicated their suitability for grafting. These patients recovered except one who suffered from co-existing disease. The electrophysiological studies also confirmed the clinical diagnosis of avulsion of the C8 and T1 roots and therefore prevented unnecessary dissection

This study was designed to test the hypothesis that the sensory innervation of bone might play an important role in sensing and responding to low-intensity pulsed ultrasound and explain its effect in promoting fracture healing. In 112 rats a standardised mid-shaft tibial fracture was created, supported with an intramedullary needle and divided into four groups of 28. These either had a sciatic neurectomy or a patellar tendon resection as control, and received the ultrasound or not as a sham treatment. Fracture union, callus mineralisation and remodelling were assessed using plain radiography, peripheral quantitative computed tomography and histomorphology.

Daily ultrasound treatment significantly increased the rate of union and the volumetric bone mineral density in the fracture callus in the neurally intact rats (p = 0.025), but this stimulating effect was absent in the rats with sciatic neurectomy. Histomorphology demonstrated faster maturation of the callus in the group treated with ultrasound when compared with the control group. The results supported the hypothesis that intact innervation plays an important role in allowing low-intensity pulsed ultrasound to promote fracture healing.

Aims

Between 2002 and 2011, 81 patients with a traumatic total brachial plexus injury underwent reconstruction by double free muscle transfer (DFMT, 47 cases), single muscle transfer (SMT, 16 cases) or nerve transfers (NT, 18 cases).