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Darrach's procedure was performed for post-traumatic symptoms in the inferior radio-ulnar joint in 36 patients, who were reviewed after a mean follow-up of 6 years. Only 18 of the patients had a satisfactory clinical result. Poor outcome was associated with osteoarthritis of the wrist, the occurrence of algodystrophy and a short ulnar remnant.
This prospective study was performed to determine the true incidence of deep vein thrombosis of the lower limb in children who had undergone halo-femoral traction to correct scoliosis before operation. Bilateral ascending phlebography of the lower limbs was performed on 54 children two days before spinal fusion and Harrington rod instrumentation. Two patients developed clinical evidence of thrombosis whilst on traction. This diagnosis was confirmed by phlebography. The other 52 children had no clinical evidence of thrombosis and their venograms were normal. The incidence of thrombosis was 3.7 per cent and clinically silent thrombosis did not occur.
The scaphoid fracture is commonest in young men in the age group 15 to 29 years, who have the highest incidence of non-union, take the longest time to unite, lose more time from work, and spend the longest time as outpatients. A union rate of 95 per cent can be achieved using standard simple treatment. All but a few fractures are visible on the first radiograph, and failure of visualisation at this stage is not associated with a bad outcome. The postero-anterior and semipronated views are the most important to scrutinise. Crank-handle injuries have a particularly bad prognosis when they produce a transverse fracture of the waist of the scaphoid. Poor prognostic factors are displacement during treatment, the fracture line becoming increasingly more obvious, and the presence of early cystic change. The severity of trauma is an important factor to elicit from the history.
