ABSTRACT
This paper comprises a retrospective study of the incidence of death from pulmonary embolism following total hip and total knee replacement surgery in a unit which does not employ routine prophylactic anticoagulation. There were a total of 1569 patients, of whom 1362 had total hip replacements and 207, knee replacements. Fatal pulmonary embolism occurred in six patients. The need for routine prophylactic anticoagulation is questioned.
Subject(s)
Hip Prosthesis , Knee Prosthesis , Pulmonary Embolism/mortality , Anticoagulants/therapeutic use , Bandages , Cerebrovascular Disorders/mortality , Chemoprevention , Follow-Up Studies , Hospitals, District/statistics & numerical data , Hospitals, General/statistics & numerical data , Humans , Incidence , Locomotion , Myocardial Infarction/mortality , Neoplasms/mortality , Pulmonary Embolism/prevention & control , Retrospective Studies , Scotland/epidemiology , Splints , Weight-BearingABSTRACT
Simple decompression of the extensor tendons at the wrist was carried out on fifty-four wrists in a total of forty-one patients with rheumatoid disease. This procedure was combined with excision of the ulnar head in forty-five wrists. Complete resolution of the synovitis occurred in 81.5 per cent of the wrists. In two patients the tendons ruptured soon after operation and in both cases this was due to prolapse of the ulnar stump after an associated Darrach procedure. The clinical results of decompression compare favourably with those of the widely accepted operation of dorsal tenosynovectomy.
Subject(s)
Arthritis, Rheumatoid/surgery , Tenosynovitis/surgery , Wrist Joint/surgery , Adult , Aged , Arthritis, Rheumatoid/complications , Female , Humans , Male , Middle Aged , Tendons/surgery , Tenosynovitis/etiologyABSTRACT
A patient with a late unreduced obturator dislocation of the hip is reported and the literature reviewed. The diagnosis was confirmed by vaginal examination. An open reduction was necessary and it is suggested that this is best achieved through an anterior approach.
Subject(s)
Hip Dislocation/therapy , Adolescent , Female , HumansABSTRACT
Seven patients with macrodactyly in the foot are reported. None showed any stigmata of neurofibromatosis and all were found to have excessive accumulation of fibro-fatty tissue as the most striking pathological feature. It is suggested that this may represent the basic lesion in this condition. The literature is reviewed and attention is drawn to the differences between macrodactyly in the hand and in the foot.
Subject(s)
Bone Diseases, Developmental/surgery , Foot Deformities, Acquired/surgery , Foot/surgery , Adipose Tissue/pathology , Amputation, Surgical , Bone Diseases, Developmental/pathology , Female , Foot Deformities, Acquired/diagnostic imaging , Foot Deformities, Acquired/pathology , Humans , Infant, Newborn , Male , Radiography , Toes/diagnostic imaging , Toes/surgeryABSTRACT
A technique of subtalar arthrodesis by means of metallic internal stabilisation and autogenous cancellous bone grafting is described. Of forty-eight feet with mobile pes planus treated by this method forty-five gained union after an average of seven and a half weeks in a below-knee weight-bearing plaster, and forty-three had satisfactory correction of the deformity.
Subject(s)
Arthrodesis , Bone Transplantation , Flatfoot/surgery , Fracture Fixation, Internal , Adolescent , Bone Screws , Calcaneus/surgery , Casts, Surgical , Child , Child, Preschool , Female , Humans , Immobilization , Male , Talus/surgery , Transplantation, AutologousABSTRACT
A case is reported of dislocation of the base of the fifth metacarpal treated by manipulation and percutaneous fixation with a Kirschner wire. Visualisation by the image intensifier confirmed the reduction. A lateral view is important to control the volar displacement.
Subject(s)
Carpal Bones , Finger Injuries/therapy , Joint Dislocations , Metacarpus , Finger Injuries/diagnostic imaging , Finger Injuries/surgery , Humans , Joint Dislocations/therapy , Male , Metacarpus/surgery , Middle Aged , RadiographySubject(s)
Abdominal Injuries/diagnosis , Duodenum/injuries , Adult , Duodenum/surgery , Female , Humans , RuptureABSTRACT
Twenty-one out of 7,866 head injuries were complicated by the development of delayed intracerebral haematomata. The age distribution of patients with this condition closely resembled that of patients with subdural haematomata and differed sharply from patients with extradural haemorrhage. This finding, combined with the fact that the two conditions often coexisted, suggests the possibility of similar aetiological factors operating in their production. The injury producing the lesion was often minor and the larger haematomata appeared to be associated with longer `asymptomatic' intervals. The neurological deterioration was in most instances clearly the result of an increase in intracranial pressure. When possible, angiography followed by definitive craniotomy was the most satisfactory method of management and multiple burr holes even when combined with needling of the hemisphere yielded unsatisfactory results. The distribution of lesions tended to confirm their traumatic origin. On no occasion was there a vascular abnormality to account for the haemorrhage and, despite the fact that the ages of most patients were in the seventh and eighth decades, the incidence of degenerative vascular disease was small. Contusional injury causes a local failure of the mechanisms that regulate cerebral blood flow. Hypoxia, hypercapnia, and venous congestion produce cerebral hyperaemia which encourages gradual haematoma formation particularly at the sites of injury. This explains not only the situation of the lesions but also the latency between the trauma and their development.