Standardised consent forms on the website of the British Orthopaedic Association.

The British Orthopaedic Association has endorsed a website, www.orthoconsent.com, allowing surgeons free access to a bank of pre-written consent forms. These are designed to improve the level of information received by the patient and lessen the risk of successful litigation against surgeons and Health Trusts.

Hartshill rectangle: failure of spinal stabilisation in acute spinal cord injury.

A high rate of failure of the internal fixation of unstable spinal fractures in complete cord injured patients was noted in patients referred to the Salisbury Spinal Centre who had been stabilised with a Hartshill rectangle. This prompted a review of the operative notes, radiographs and clinical outcomes of all patients referred to the centre with a Hartshill rectangle in situ. All patients identified with a complete spinal cord injury and Hartshill rectangle were identified. Forty-three such patients referred from 13 different centres were found. Pre- and postoperative radiographs were assessed for fracture pattern and for spinal correction. Operative outcome in terms of pain and complications relating to surgery were identified. The most recent radiographs were assessed for signs of loss of reduction or stabilisation. Follow-up averaged 84 months (range 36-132 months). Of the 43 identified patients, 19 were found to have unsatisfactory stabilisation. Persistent pain, broken implants and worsening kyphosis were the main complications. The failure to use bone graft at the time of stabilisation was significantly (P < 0.001) related to risk of failure. The application and use of the Hartshill is not a technically challenging procedure; however, if the system is to be used, it must be used correctly. Failure to correctly apply the rectangle and to use bone graft will lead to an unacceptably high rate of failure.

Complications of spinal surgery in acute spinal cord injury.

Despite an increasing realisation that patients with acute spinal cord injuries require a multidisciplinary approach for their management, which can only be satisfactorily provided in spinal injuries units, these units are still not being used to their full potential in the United Kingdom. Not surprisingly, the initial admission of patients to other hospitals has inevitably led to delays in transfer to such units, with a high incidence of complications. The results of spinal surgery were studied in 420 consecutive patients with spinal cord injury admitted to the Duke of Cornwall Spinal Treatment Centre, Salisbury. Complications were more frequent in patients undergoing spinal surgery before transfer to the centre. Furthermore, the longer the delay in transfer, the higher the incidence of pressure sores. Suggestions are made as to how complications can be avoided in future.

Long-term survival of a patient with malignant lymphoma of bone.

Malignant lymphoma of bone is an uncommon tumour. A number of studies have outlined the clinicopathological findings and overall favourable prognosis in adults. We report on a woman whose tumour was originally diagnosed as a secondary carcinoma of the upper femur. Twenty-three years later following proximal femoral replacement, the original histology was reviewed using immunohistochemical techniques and revised to B-cell malignant lymphoma of bone.

Reversed dynamic slings: results of use in the treatment of post-traumatic flexion contractures of the elbow.

We report our experience with reversed dynamic slings used in the treatment of post-traumatic flexion contractures of the elbow. There were 21 patients treated for deformities ranging from 35 degrees to 70 degrees (average 55 degrees). The flexion deformity after treatment varied from 25 degrees to 45 degrees (average 34.8 degrees), giving an average increase in range of movement of 39.1 per cent.

Use of an F-clamp for fracture reduction during closed intramedullary nailing of the femur.

Reduction of a femoral shaft fracture before introducing a guidewire may be difficult, and time consuming. We report the use of a clamp to facilitate reduction and reduce exposure of the operator to radiation.

Trigger wrist phenomenon in rheumatoid arthritis.

Flexor tendon synovitis in patients with rheumatoid arthritis commonly presents with a carpal tunnel syndrome and a concomitant trigger finger. Triggering at the wrist joint is in this disease an uncommon additional feature. In the two cases reported, histological examination of the tissue has indicated that, as well as chronic synovitis, there was a true rheumatoid nodule present at the wrist joint, either pedunculated or fusiform. The passage of the nodule, with a 'Click' from the proximal side of the transverse carpal ligament to the distal aspect, when the fingers are flexed, creates the sensation, signs and symptoms of a trigger wrist.

Chronic osteomyelitis of the thoracic spine due to Salmonella typhi: a case report.

A young woman with a 12-year history of symptoms of osteomyelitis of her spine had been treated for unproven tuberculous disease. During an acute flare-up of her symptoms, bacteriologic proof of Salmonella typhi infection was obtained, and the patient was treated with chloramphenicol and amoxycillin. The case illustrates the difficulties involved in making a radiologic diagnosis and the value of obtaining bacteriologic identification of the organism.