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Seventy patients who underwent Russell-Taylor interlocking nailing of acute tibial fractures between 1989 and 1994 were studied retrospectively. Patients were followed to radiological union.The 70 patients consisted of 56 males and 14 females with an average age of 44 years (range, 16-90 years). There were 60 closed fractures and 10 open fractures. Sixty-six fractures were treated by closed nailing...
An X-ray-based image intensification system is a necessary operative aid in many orthopaedic procedures. Technological advances have not only increased the resolution of these systems, but allow the production of thermal images. We have compared such images obtained at the time of surgery with postoperative radiographs in 80 patients who underwent closed reduction and internal fixation for proximal...
Injury severity scoring systems are well established in the assessment of injured victims. A descriptive scoring system for injuries to the hand, distal to the carpus, has been designed and validated.Each ray of the hand is examined separately for injury in the four broad anatomical categories of integument, skeletal, motor and neural. The score for each ray is multiplied by a weighting factor...
Interlocking nails have been available for the treatment of humeral shaft fractures in our unit since 1991. A retrospective review was carried out to assess the results of all patients receiving a nail over a 3-year period. Forty-three patients with fractures of the humeral shaft were treated by locked intramedullary nailing, using the Russell-Taylor nailing system. The indications for operation...
A fracture stiffness of 15 Nm/degree measured biomechanically has been proposed as a reliable indicator of early fracture union. This study used a fracture model to examine the ability of orthopaedic surgeons to assess the stiffness of a fracture manually. Twenty orthopaedic surgeons were tested along with 20 controls. They each estimated the stiffness of seven rods representing mid-shaft diaphyseal...
All cases of major injury (Injury Severity Score (ISS) > 15) admitted to the two Leeds hospitals in 1988-1989 were compared to all cases admitted in 1991-1993, to ascertain if a system of trauma care which had evolved in the hospitals during this time had affected outcome of these patients. Significant improvements in survival were shown especially in less seriously injured patients.Data from an...
Our main objective was to assess the long-term outcome in children after severe blunt injuries. A 5-year clinical follow-up was conducted on children aged 15 years or less when they sustained their injuries, who were resident in Mersey region and surrounding areas, and left hospital alive after sustaining severe blunt injuries (ISS > 15) between 19 May 1989 and 19 April 1990. All parents and...
Ten patients with pathological proximal femoral fractures were treated with the Variwall reconstruction nail. There were five intertrochanteric, one combined shaft and neck, and four subtrochanteric fractures fixed by this method. The mean age was 71 (54-90). The purpose of this study was to assess the use of a reconstruction nail in pathological fractures around the intertrochanteric region. ...
The coexistence of traumatic locked cervical facet dislocation and disc herniation is not well described despite the incidence being as high as 60 per cent. The traditional protocol for cervical facet dislocation suggests closed reduction (CR) using traction and/or manipulation. In the event of unsuccessful CR, open reduction and stabilization by the posterior approach is the usual procedure. In...
The successful management of low supracondylar fractures of the adult humerus is difficult. In the elderly, where osteoporosis complicates surgical treatment, non-union is not uncommon and can occur after surgical or non-operative methods of treatment. Significant disability may result from a painful flail arm, and ulnar neuropathy may complicate the picture.Complex and demanding methods of internal...
Although the case for better trauma care in the UK has been well described over the past decade and there have been a number of high-profile interventions such as the Advanced Trauma Life Support course, the Major Trauma Outcome Study, the Trauma Centre experiment in Staffordshire and the development of a British paramedic service, there has been relatively little published on the lower profile but...
Four children, who developed ulnar nerve palsy following percutaneous fixation of supracondylar fracture of the humerus by Kirschner wires (K-wires) are reported. In one the K-wire was removed within 48 h and the neuropraxia recovered immediately. In the other three patients recovery took an average of 6 weeks after removal of the wires and only after exploration of the ulnar nerve. The nerve was...
A prospective study was made of 1500 elderly patients who suffered from acute hip fractures from 1986 to 1990. There were 36 per cent more fractures in the 6 colder months from November to April than in the rest of the year (P < 0.001). A strong correlation between the monthly adjusted fracture rate and the average lowest ambient temperature was also observed (P < 0.001). The fractures occurred...
In a prospective study of 69 patients with gunshot arterial injuries to the groin, there were 18 patients with iliac and 51 with femoral artery injuries. In the former group, the majority of patients were admitted with gross physiological derangement that did not respond to pre-operative resuscitation, so were taken directly to theatre. There was a 39 per cent peri-operative mortality. A prompt...
Injury of the ulnar nerve may occur when using percutaneous Kirschner wires (K-wires) in the treatment of supracondylar humeral fractures of the elbow especially in children whose bony landmarks are masked by swelling. We describe a technique in which this complication can be avoided during the procedure. The nerve is located first using a needle attached to a nerve stimulator. The K-wire is then...
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