Showing papers in "Injury-international Journal of The Care of The Injured in 1979"
TL;DR: Of 131 patients with mild concussion, 19 (14.5%) still had symptoms after 1 year, and eight of these patients were involved in law suits and 6 had been suspected of malingering 6 weeks after their accident.
Abstract: Of 131 patients with mild concussion, 19 (14.5%) still had symptoms after 1 year. Of these 19 patients, 10 had some symptoms of which they had not complained at 6 weeks. Symptoms at 1 year were more common among women and among patients who had had positive neurological findings at 24 h. Of the 19 patients who had symptoms at 1 year, 8 were involved in law suits and 6 had been suspected of malingering 6 weeks after their accident. Five of these patients were both involved in law suits and suspected of malingering.
382 citations
TL;DR: The features of 3500 patients with head injury who attended accident and emergency departments in Scotland during 1974 are described and criteria which are important when assessing whether a head-injured patient should be admitted to hospital are listed.
Abstract: The features of 3500 patients with head injury who attended accident and emergency departments in Scotland during 1974 are described. These represented 10 per cent of all attenders at these departments. Recent alcohol consumption was noted in 25 per cent of adult males; this was commonest amongst those who were victims of assault or pedestrians involved in traffic accidents. Forty-one per cent of patients had scalp wounds; 58 per cent had radiographs of the skull taken and of these 2.7 per cent had fractures of the skull. Although 20 per cent of patients had altered consciousness at some time, only 5 per cent showed any evidence of impaired consciousness when seen at hospital. Twenty-three per cent of those attending were admitted to hospital. Criteria which are important when assessing whether a head-injured patient should be admitted to hospital are listed.
89 citations
TL;DR: There is now a growing body of evidence that a positive attitude to head injury care can have a material influence on morbidity and mortality, because some of this is due to secondary brain damage which is potentially preventable.
Abstract: THE lecture 'Who cares for head injuries?' (JenneR, 1975a), which I gave to this Institute three years ago, might have carried the subtitle, 'Does it matter?'. I believe that many accident, general and orthopaedic surgeons, who look after most of the head injuries admitted to hospital, often think, even if they don't say it, that it probably doesn't matter too much. They suspect that most mild injuries get better, however little is done for them, and that most severe injuries do badly, however much is done for them. This contrasts with the Hippocratic aphorism, 'No injury is too trivial to be ignored, or too serious to be despaired of'. There is now a growing body of evidence that a positive attitude to head injury care can have a material influence on morbidity and mortality, because some of this is due to secondary brain damage which is potentially preventable. I shall review this evidence and shall indicate how changes in attitude and in organization might improve the care of patients with head injury.
85 citations
TL;DR: Infection was the most serious complication, with a deep sepsis rate of 10.5 per cent, but fixation failure, delayed union and refracture also occurred.
Abstract: Summary The complications encountered in the compression fixation of 70 cortical long bone fractures are reviewed. The results represent the initial experience with the AO fixation equipment following its introduction to a centre with staff relatively untrained in the technique. Infection was the most serious complication, with a deep sepsis rate of 10.5 per cent, but fixation failure, delayed union and refracture also occurred. The various problems are discussed in detail and suggestions are made as to how they can be avoided.
61 citations
TL;DR: Primary total hip replacement for displaced subcapital fractures may be performed with an acceptable mortality and the majority of patients who were reviewed after operation experienced few symptoms and 87 per cent were able to walk independently.
Abstract: Primary total hip replacement for displaced subcapital fractures may be performed with an acceptable mortality. The majority of a series of patients who were reviewed after operation experienced few symptoms and 87 per cent were able to walk independently. These results compared favourably with other forms of management, and deterioration was seldom observed.
58 citations
TL;DR: Except for one patient with persistent radial paraesthesiae, full spontaneous recovery occurred in 7 patients who had sustained either anterior interosseous, posterior interOSseous or radial nerve lesions, and the mean time of follow-up was three years and nine months.
Abstract: Twenty-one patients with acute injury of either the median, ulnar, radial, anterior interosseous or posterior interosseous nerves associated with 1540 closed fractures or dislocations of the elbow have been reviewed. The mean time of follow-up was three years and nine months. Nine patients, 6 of whom had ulnar nerve lesions, had persistent evidence of nerve damage. Five patients sustained median nerve lesions complicating supracondylar fractures of the humerus. One patient, in whom there was no evidence of nerve recovery at five months, made a full recovery following neurolysis. Of the 9 patients who sustained ulnar nerve lesions, 2 required neurolysis and anterior transposition of the nerve, at two months and five months respectively, to facilitate recovery. Except for one patient with persistent radial paraesthesiae, full spontaneous recovery occurred in 7 patients who had sustained either anterior interosseous, posterior interosseous or radial nerve lesions.
58 citations
TL;DR: A prospective study was carried out on 142 fresh fractures of the tibial shaft treated by internal fixation according to the AO principles, 99 fractures being closed and 43 open, with the overall infection rate being 14 per cent, 7 per cent having major infection and only 1 case requiring removal of the plate.
Abstract: A prospective study was carried out on 142 fresh fractures of the tibial shaft treated by internal fixation according to the AO principles, 99 fractures being closed and 43 open A total of 140 cases was reviewed at 1 year and 125 cases at 2 years following injury, at which times a functional assessment score was awarded by the surgeon and the patient himself, and a precise measurement of ankle range was made The time taken for the fracture to unite and the incidence of non-union was greater if the fracture was comminuted (whether open or closed) than if there was no comminution For patients with closed fractures the minor infection rate (erythema and increased local temperature) was 41 per cent and the major infection rate (pus present) was 41 per cent, no infection being severe enough to warrant removal of the plate In open fractures, the overall infection rate was 14 per cent, 7 per cent having major infection and only 1 case requiring removal of the plate The functional results and complications are discussed
34 citations
TL;DR: A case of transposition of the radius and ulna associated with posterior dislocation of the elbow in a child is reported.
Abstract: A case of transposition of the radius and ulna associated with posterior dislocation of the elbow in a child is reported.
33 citations
TL;DR: There has been a 50 per cent increase in the number of motocyclists treated at Newcastle General Hospital Casualty Department over the past six months, and suggestions for positive prevention of motorcycle accidents are made.
Abstract: Ther were over 1000 fatal motorcycle accidents in Britain during 1976, which cost the taxpayer over pounds 40 million. There has been a 50 per cent increase in the number of motocyclists treated at Newcastle General Hospital Casualty Department over the past six months. Most accidents occur with young inexperienced male drivers, making elementary driving errors. Suggestions for positive prevention of motorcycle accidents are made. Of paramount importance is the need for consideration of compulsory formal training and enactment of the motorcycle lighting-up law.
29 citations
TL;DR: In this series stainless-steel and titanium plates gave the same excellent results and there was no difference to be seen between the radiological patterns of fracture healing in the two groups.
Abstract: A consecutive series of 256 fractures of the shaft of the tibia treated by internal fixation with a narrow dynamic compression plate (DCP) is presented. In 123 cases the plates were made of titanium and in 133 cases they were made of stainless-steel. In both groups the age distribution of the patients, the period between operation and the final review and the time of removal of the metal were comparable. All these fractures resulted from skiing accidents. Eighty-six per cent of the 256 fractures were reviewed between 1 and 2 years after the operation. Ninety-one per cent of the titanium group and 93 per cent of the stainless-steel group showed full recovery without any loss of movement in the joints. In both groups there was the same number of refractures, which were chiefly due to subsequent accidents. There were no cases of local wound infection, osteitis or non-union. Furthermore, there was no difference to be seen between the radiological patterns of fracture healing in the two groups. In this series stainless-steel and titanium plates gave the same excellent results.
27 citations
TL;DR: Seventeen patients with double vertical fractures of the pelvic girdle were treated by early reduction and subsequent fixation ofThe pelvic ring with a trapezoid frame provided firm fixation of the fractured pelvis.
Abstract: Seventeen patients with double vertical fractures of the pelvic girdle were treated by early reduction and subsequent fixation of the pelvic ring with a trapezoid frame. This provided firm fixation of the fractured pelvis. With the frame attached, patients without associated injuries were allowed out of bed within 3 weeks and in every case the frame was removed 6 weeks after its application. External fixation of the pelvic fracture afforded relief from pain and greatly facilitated nursing. At follow-up, all the fractures had united in the position secured initially by the frame and no patient complained of pain in the sacro-iliac joints.
TL;DR: Occlusion of the axillary artery occurred in a man with erect dislocation of the shoulder with an associated fracture of the greater tuberosity of the humerus, which required open reduction and internal fixation.
Abstract: Summary Occlusion of the axillary artery occurred in a man with erect dislocation (luxatio erecta) of the shoulder. This combination of injuries has not previously been reported. The arterial injury was demonstrated by arteriography and repaired by a vein graft. There was an associated fracture of the greater tuberosity of the humerus, which required open reduction and internal fixation.
TL;DR: It is suggested that, in order to reduce the incidence of varus deformity in suprocondylar fractures, open reduction and internal fixation is indicated in those fractures in which tilt or medial rotation cannot be reduced by conservative means.
Abstract: Eighty cases of supracondylar fracture of the humerus at the elbow in children have been analysed The post-reduction radiograph of the fracture was classified depending on the residual deformity present and related to the loss of carrying angle and cubitus varus deformity at the time of follow-up Fifty-four percent of the displaced fractures showed a loss of carrying angle greater than 5 degrees, and of these 23 per cent developed cubitus varus deformity Eighty-five per cent of those cases with a loss of carrying angle greater than 10 degrees showed either residual tilt or medial rotation on the post-reduction radiograph All cases in which there was residual medial tilt after manipulation and 40 per cent of those with medial rotation on the post-reduction radiograph developed cubitus varus In our series, there was no evidence of epiphyseal injury causing the deformity and in none of the cases was the deformity progressive It is suggested that, in order to reduce the incidence of varus deformity in suprocondylar fractures, open reduction and internal fixation is indicated in those fractures in which tilt or medial rotation cannot be reduced by conservative means
TL;DR: Thirty cases of fracture of the femur occurring in patients following Moore's arthroplasty have been reported, with a complication rate of 56 per cent, including five deaths, and Operative management appears to be the best treatment for these injuries.
Abstract: Summary Thirty cases of fracture of the femur occurring in patients following Moore's arthroplasty have been reported. The fracture patterns can be classified according to the relationship of the fracture line to the stem's tip. Type I fractures occur in the intertrochanteric area and are stable since both femoral fragments are held by the prosthesis. Type II fractures occur between the trochanteric line and the stem's tip and are also stable; the more proximal the fracture, the greater the stability. Type III fractures are grossly unstable since the prosthetic stem has no purchase on the distal femur. Type I and type II fractures can be treated successfully in traction, and complications, particularly in type I injuries, are uncommon. Type III fractures are difficult to treat. The complication rate for these fractures was 56 per cent, including five deaths. Most major complications occurred in patients treated by traction. Operative management appears to be the best treatment for these injuries so that the complications of prolonged bedrest can be avoided. Although a variety of operative methods have been attempted, replacement with a long-stemmed Moore's prosthesis, intramedullary bone cement and cerclage wiring is recommended. Operative treatment is not without hazard, however, and should be undertaken only if stabilization of the fracture can be assured. Since complications of both operative and conservative treatment are common, attention should be directed towards prevention.
TL;DR: The results support the theory that healing in the digital sheath is necessarily mediated through the formation of adhesions, and Sterispon wrapping has been helpful after tenolysis operations.
Abstract: The influence of Sterispon (Allen & Hanbury) wrapping on the healing of the rabbit flexor digitorum profundus tendon sutured within the digital sheath was studied. Control tendons healed in 2 weeks in association with thick adhesions. The wrapped tendons were surrounded with fewer adhesions, but 50 per cent separated. Healing was delayed until adhesions reached the suture site. A sheath of a single layer of mesothelial cells formed on the surface of the Sterispon opposite the tendon and this markedly reduced adhesions at the suture site. The cellular reaction was bland. Sterispon wrapping had a similar effect on tendon healing and adhesion formation as wrapping with other non-absorbable substances and the results support the theory that healing in the digital sheath is necessarily mediated through the formation of adhesions. Sterispon wrapping has been helpful after tenolysis operations.
TL;DR: There was a history of hemiplegia due to stroke in 97 (6.5 per cent) of 1483 consecutive patients with fresh fractures of the neck of the femur and internal fixation was technically satisfactory in trochanteric fractures, but failed frequently in cervical fractures.
Abstract: There was a history of hemiplegia due to stroke in 97 (6.5 per cent) of 1483 consecutive patients with fresh fractures of the neck of the femur. Both cervical and trochanteric fractures occurred significantly more often on the hemiplegic side. Internal fixation was technically satisfactory in trochanteric fractures, but failed frequently in cervical fractures.
TL;DR: There is a quantitative correlation between the alterations in the level of consciousness and the fasting blood-glucose and serum-insulin levels in brain-injured patients, suggesting that certain cerebral structures take part in the regulation of the basal insulin secretion.
Abstract: Serial fasting blood glucose and basal serum insulin were measured in brain-injured patients. The endocrine changes were compared with the level of consciousness. Evaluating the serial examinations of 92 brain-injured and 31 control patients we came to the following conclusions. There is a quantitative correlation between the alterations in the level of consciousness and the fasting blood-glucose and serum-insulin levels in brain-injured patients. Deep coma is connected with a high blood-sugar level, clear consciousness with a normal glucose level. The insulin level is, however, decreased in the comatose state and normal in the state of clear consciousness. According to the alterations in blood-glucose and insulin levels, brain-injured patients can be divided into four groups. The alterations in the insulin level cannot give a proper explanation of the blood-sugar changes. Some changes in the levels of both blood glucose and serum insulin may have prognostic significance. According to our results it can be supposed that certain cerebral structures take part in the regulation of the basal insulin secretion.
TL;DR: Three cases of 'idiopathic pneumoperitoneum' following injury are reviewed and it is likely that artificial respiration induced pneum operitoneum in these cases.
Abstract: Three cases of 'idiopathic pneumoperitoneum' following injury are reviewed. Two cases occurred several days after initial injury and were associated with post-traumatic pneumothorax and artificial respiration. It is likely that artificial respiration induced pneumoperitoneum in these cases. The third case of pneumoperitoneum occurred one hour after initial injury and was associated with bilateral pneumothoraces and pneumopericardium. Congenital abnormalities and tension pneumothorax were thought to account for this case of 'idiopathic pneumoperitoneum'.
TL;DR: The use of acrylic cement to secure the tibial transfixing pins to the external bar and the ability to apply compression across the fracture site are the salient features of this technique, which is simple to use and inexpensive.
Abstract: Summary A new method of external fixation for complicated fractures of the tibia is described. The use of acrylic cement to secure the tibial transfixing pins to the external bar and the ability to apply compression across the fracture site are the salient features of this technique, which is simple to use and inexpensive.
TL;DR: A case of fatal cervical dislocation in a front seat passenger restrained by a retractable three-point belt strapped to the back of the seat is described.
Abstract: A case of fatal cervical dislocation in a front seat passenger restrained by a retractable three-point belt is described. A biomechanical and technical analysis is given.
TL;DR: It is concluded that facial injuries constitute a significant proportion of the work of a civilian accident unit and that any accident service must have adequate facilities for the management of these injuries.
Abstract: Over a period of one year 20 549 new patients attended an accident and emergency department. Of these patients, 15 555 were victims of accidents, including 875 who had sustained facial injuries. This latter group comprised 609 patients with soft tissue trauma and 266 with skeletal injury. The frequency, aetiology, age and sex distribution of the facial injuries were analysed and compared with other published statistical surveys of facial injury. It is concluded that facial injuries constitute a significant proportion of the work of a civilian accident unit and that any accident service must have adequate facilities for the management of these injuries. Language: en
TL;DR: The presence of an effusion was associated with an increase in the time required for full recovery and the use of these changes in the diagnosis of minor elbow injuries and the assessment of their clinical progress.
Abstract: Summary Alterations occur in the radiological appearance of the soft tissues after injury to the elbow joint. These are due to displacement of the intra-articular fat pads by capsular distension when an effusion is present. A prospective study of 89 consecutive elbow injuries was undertaken in an attempt to assess the usefulness and reliability of these changes in the diagnosis of minor elbow injuries and the assessment of their clinical progress. In 61 elbows (69 per cent) there was no radiological evidence of an effusion and no evidence of bony injury. All quickly returned to normal. In 28 elbows (31 per cent) radiological evidence of an effusion was present. Twenty-three (80 per cent) of these were also found to have a fracture in, or adjacent to the elbow joint. In 9 elbows the fracture could not be seen on the initial radiographs. Because of the presence of an effusion, repeat radiographs were taken and a fracture discovered. The presence of an effusion was associated with an increase in the time required for full recovery.
TL;DR: Forty-six injuries caused by skateboards were seen in 3 months; these were predominantly fractures and sprains of the distal part of the limb caused by indirect violence.
Abstract: Forty-six injuries caused by skateboards were seen in 3 months; these were predominantly fractures and sprains of the distal part of the limb caused by indirect violence. These injuries are likely to become common. They occur most frequently when the skateboard hits a stone or other irregularity on the surface used.
TL;DR: Previously undescribed histological appearances demonstrate osteogenic potential and the significance of subcutaneous Achilles tenotomy is discussed.
Abstract: A case of rupture of an ossified Achilles tendon is described. It is suggested that the management of this condition is surgical. Previously undescribed histological appearances demonstrate osteogenic potential. The significance of subcutaneous Achilles tenotomy is discussed.
TL;DR: A method of internal fixation of the disrupted symphysis publis is discribed which uses readily available AO plates and tools and represents a considerable saving in nursing time and a great improvement for the patient, who is usually free from pain after 1 week.
Abstract: A method of internal fixation of the disrupted symphysis publis is discribed which uses readily available AO plates and tools. Patients can be mobilized at 3 days and discharged within 2 weeks. This method of treatment represents a considerable saving in nursing time and a great improvement for the patient, who is usually free from pain after 1 week.
TL;DR: The reason for this procedure, after considering the patient's age and activity and the type of fracture, was to avoid the sequelae of resection of the radial head.
Abstract: Eight cases of internal fixation for fractures of the proximal end of the radius in adults are discussed. The reason for this procedure, after considering the patient's age and activity and the type of fracture, was to avoid the sequelae of resection of the radial head. By following an appropriate technique, and provided that there are no complications, the results obtained have been excellent.
TL;DR: The results conclusively show that the early weight bearing regime results in the fractures uniting in half the time of the late weight bearing series.
Abstract: Summary The paper describes a simple and effective practical method of dealing with the fractures of the tibia by means of a long-leg walking plaster-of-Paris cast. The results are assessed in a series of 44 patients, 28 of whom were treated by early weight bearing, while the remaining 16 were treated by traditional closed methods. A simple system of grading tibial fractures is described in order to facilitate valid comparisons. The results conclusively show that the early weight bearing regime results in the fractures uniting in half the time of the late weight bearing series. Details of two cases in each grade of the early weight bearing series are given.
TL;DR: Analysis of the results of von Bahr screw fixation shows that the failures are due to inadequate reduction of the displacement during operation, especially when the head is in varus, and to bad positions of the screw.
Abstract: This article presents the results of von Bahr screw fixation in 103 patients, allowing immediate weight bearing. After a follow-up period of 1 year, a failure rate of 18% was recorded. Analysis of the series shows that the failures are due to inadequate reduction of the displacement during operation, especially when the head is in varus, and to bad positions of the screw. The high failure rate was not related to the initial displacement of the fracture.
TL;DR: A review of 197 cases of non-union and pseudarthrosis of long bones fixed internally with thick metal nails after preliminary reaming of the medullary canal found the rigid fixation of the fragments allowed early movement of the limb and so avoided the complications of prolonged immobilization.
Abstract: This paper is based on Kuntscher's method of operative treatment of the long bones(Kuntscher, 1962) and is a review of 197 cases of non-union and pseudarthrosis of long bones fixed internally with thick metal nails after preliminary reaming of the medullary canal. New reamers and a new nail have been designed and the results are satisfactory. The rigid fixation of the fragments allowed early movement of the limb and so avoided the complications of prolonged immobilization. Anabolic steroids were administered as a routine to this group of patients. Weight bearing and full function of the limb were regained within 3-5 months of the operation. Poor results occurred in 6 cases (3.2 per cent) due to exacerbation of chronic osteomyelitis.