The current practice of the management of little finger metacarpal fractures--a review of the literature and results of a survey conducted among upper limb surgeons in the United Kingdom.

Little finger metacarpal fractures are the most common type of metacarpal fractures and the treatment is quite variable as it is a multifactorial entity comprised of subcapital, metacarpal shaft and base fractures. These fractures are common presentations in the fracture clinics and the general orthopaedic surgeons treat them until a complex case warrants specific decision making by a hand surgeon. The management of many of these fractures is still a matter of debate and differ widely in the various parts of the United Kingdom. The aim of this study was to investigate the current practice of little finger metacarpal fractures among upper limb surgeons in the UK. We conducted an online survey among 278 upper limb orthopaedic specialist surgeons throughout the UK. Our response rate was 58%. There are various factors which dictate the treatment as suggested by these respondent upper limb consultants. For example, for fifth metacarpal neck fractures, it was generally recognised that 43% of upper limb surgeons prefer neighbour strapping alone for non-operative management of little finger metacarpal fractures. For little finger metacarpal shaft fractures, 39.3% of surgeons suggested that they would contemplate intervention, i.e. manipulation under anaesthesia/surgery if beyond 30° of volar angulation is present. For little finger metacarpal neck fractures, 33.7% would only consider surgical intervention beyond 60° of volar angulation. 91.6% of upper limb specialists agreed that they would operate on little finger metacarpal base fractures only if it was a fracture dislocation, while 71.8% suggested that they would proceed to operate on even a pure dislocation. We have illustrated the various permutations and combinations of these fractures with the results of our survey in this article in detail. The vast majority of metacarpal bone fractures are stable and treated conservatively. The different types of injury patterns must be recognised by the orthopaedic surgeons and appropriate treatment then should be executed to serve the patient optimally in due course.

Effects of hydrology and field management on phosphorus transport in surface runoff.

Phosphorus (P) losses from agricultural landscapes arise from the interaction of hydrologic, edaphic, and management factors, complicated by their spatial and temporal variability. We monitored sites along two agricultural hillslopes to assess the effects of field management and hydrology on P transfers in surface runoff at different landscape positions. Surface runoff varied by landscape position, with saturation excess runoff accounting for 19 times the volume of infiltration excess runoff at the north footslope position, but infiltration excess runoff dominated at upslope landscape positions. Runoff differed significantly between south and north footslopes, coinciding with the extent of upslope soil underlain by a fragipan. Phosphorus in runoff was predominantly in dissolved reactive form (70%), with the highest concentrations associated with upper landscape positions closest to fields serving as major sources of P. However, the largest loads of P were from the north footslope, where runoff volumes were 24 times larger than from all other sites combined. Loads of P from the north footslope appeared to be primarily chronic transfers of desorbed soil P. Although runoff from the footslope likely contributed directly to stream flow and hence to stream water quality, 27% of runoff P from the upslope sites did not connect directly with stream flow. Findings of this study will be useful for evaluating the critical source area concept and metrics such as the P-Index.

Rotational dislocation of the proximal interphalangeal joint of the finger.

We describe a case of rotational dislocation of the proximal interphalangeal joint of the ring finger. This injury was not initially appreciated and therefore closed reduction failed. The clinical findings included puckering of the skin on the dorsum of the joint and rotational incongruity on radiographs. At open reduction there was interposition of the lateral band. Identification of the pathology allows early successful treatment.

Hydrology of small field plots used to study phosphorus runoff under simulated rainfall.

Use of small plots and rainfall simulators to extrapolate trends in runoff water quality requires careful consideration of hydrologic process represented under such conditions. A modified version of the National Phosphorus Runoff Project (NPRP) protocol was used to assess the hydrology of paired 1 x 2 m plots established on two soils with contrasting hydrologic properties (somewhat poorly drained vs. well drained). Rain simulations (60 mm h(-1)) were conducted to generate 30 min of runoff. For the somewhat poorly drained soil, simulations were conducted in October and May to contrast dry conditions typically targeted by NPRP protocols with wet conditions generally associated with natural runoff. For the well-drained soil, only dry conditions (October) were evaluated. Under dry antecedent moisture conditions, an average of 64 mm of rainfall was applied to the somewhat poorly drained soil to generate 30 min of runoff, as opposed to 96 mm to the well-drained soil. At an extreme, differences in rainfall were equivalent to a 50-yr rainfall-return period. An absence of detectable spatial trends in surface soil moisture suggests uniformity of runoff processes within the plots. No differences in applied rainfall were evident between wet and dry antecedent conditions for the somewhat poorly drained soil. However, significant differences in runoff generation processes were observed in dissolved P concentrations between wet and dry conditions. As natural runoff from the somewhat poorly drained soil is largely under wet antecedent conditions, this study highlights the need for care in interpreting findings from generalized protocols that favor infiltration-excess runoff mechanisms.

An unusual presentation of whiplash injury: long thoracic and spinal accessory nerve injury.

Whiplash injuries from motor vehicle accidents are very common. The usual presentation and course of this condition normally results in resolution of symptoms within a few weeks. Brachial plexus traction injuries without any bone or joint lesion of the cervical spine have been reported before. We report a case where a gentleman was involved in a rear end vehicle collision, sustained a whiplash injury and was later found to have a long thoracic nerve palsy and spinal accessory nerve palsy. Although isolated injuries of both nerves following a whiplash injury have been reported, combined injury of the two nerves following a whiplash injury is very uncommon and is being reported for the first time.

Enhanced neuroprotective effect by combination of bromocriptine and Hypericum perforatum extract against MPTP-induced neurotoxicity in mice.

The present study has been designed to evaluate the combined effect of bromocriptine (BRC) and Hypericum perforatum extract (HPE) on 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced Parkinson's disease in male Swiss Albino mice, which were randomly divided into seven groups of six animals each. Group I served as control. Groups II and III were given 300 mg/kg HPE (po) and 10 mg/kg BRC (i.p.) respectively, once daily for 7 days. The four doses of MPTP (20 mg/kg) were administered intraperitoneally with an interval of 2 h to the groups IV, V, VI and VII. The drug treatment was given to fifth group (10 mg/kg BRC; i.p), sixth group (300 mg/kg HPE; po) and seventh group (300 mg/kg HPE; po and 10 mg/kg BRC; i.p.) once in a day for 7 days and the dose on the first day was given 30 min prior to first MPTP injection. The rotarod test, hang test and forepaw stride length revealed significant improvement by the combined treatment. Dopamine and DOPAC levels were significantly improved (p<0.05). There was a significant reduction in lipid peroxidation after the combined treatment (p<0.05) and the antioxidant status was improved. These findings suggest that the combined effect of BRC and HPE was more pronounced than BRC or HPE alone. So it is concluded that the combined treatment might be preferable to either BRC (or) HPE alone in the effective clinical management of Parkinson's disease.

Role of rainfall intensity and hydrology in nutrient transport via surface runoff.

Loss of soil nutrients in runoff accelerates eutrophication of surface waters. This study evaluated P and N in surface runoff in relation to rainfall intensity and hydrology for two soils along a single hillslope. Experiments were initiated on 1- by 2-m plots at foot-slope (6%) and mid-slope (30%) positions within an alfalfa (Medicago sativa L.)-orchardgrass (Dactylis glomerata L.) field. Rain simulations (2.9 and 7.0 cm h(-1)) were conducted under wet (spring) and dry (late-summer) conditions. Elevated, antecedent soil moisture at the foot-slope during the spring resulted in less rain required to generate runoff and greater runoff volumes, compared with runoff from the well-drained mid-slope in spring and at both landscape positions in late summer. Phosphorus in runoff was primarily in dissolved reactive form (DRP averaged 71% of total P), with DRP concentrations from the two soils corresponding with soil test P levels. Nitrogen in runoff was mainly nitrate (NO3-N averaged 77% of total N). Site hydrology, not chemistry, was primarily responsible for variations in mass N and P losses with landscape position. Larger runoff volumes from the foot-slope produced higher losses of total P (0.08 kg ha(-1)) and N (1.35 kg ha(-1)) than did runoff from the mid-slope (0.05 total P kg ha(-1); 0.48 kg N ha(-1)), particularly under wet, spring-time conditions. Nutrient losses were significantly greater under the high intensity rainfall due to larger runoff volumes. Results affirm the critical source area concept for both N and P: both nutrient availability and hydrology in combination control nutrient loss.

Aggressive digital papillary adenocarcinoma presenting as a paronychia of the finger.

Aggressive digital papillary adenocarcinoma is a rare skin adnexal tumour, which has a predilection for the digits. We report a case of this tumour presenting as a simple nail bed infection.

Unilateral limitation of abduction of the hip. A valuable clinical sign for DDH?

Between 1992 and 1997, we undertook a prospective, targeted clinical and ultrasonographic hip screening programme to assess the relationship between ultrasonographic abnormalities of the hip and clinical limitation of hip abduction. A total of 5.9% (2 of 34) of neonatal dislocatable hips and 87.5% (7 of 8) of 'late' dislocated hips seen after the age of six months, presented with unilateral limitation of hip abduction. All major (Graf type III) and 44.5% of minor (Graf type II) dysplastic hips presented with this sign. Statistically, bilateral limitation of hip abduction was not a useful clinical indicator of underlying hip abnormality because of its poor sensitivity, but unilateral limitation of abduction of the hip was a highly specific (90%) and reasonably sensitive sign (70%). It was more sensitive than the neonatal Ortolani manoeuvre, which has been considered to be the method of choice. It was, however, not sensitive enough to be of value as a routine screening test in developmental dysplasia of the hip. We consider unilateral limitation of hip abduction to be an important clinical sign and its presence in an infant over the age of three to four months makes further investigation essential.

Simultaneous Bennett's fracture and metacarpophalangeal dislocation of the same thumb in a soccer player.

Double dislocations of finger joints are rare. An unusual case of a simultaneous Bennett's fracture/dislocation ofthe carpometacarpal joint and a dorsal dislocation of the metacarpophalangeal joint of the same thumb, and the management of this injury are reported. The patient had an excellent functional result.

Ultrasound screening for hips at risk in developmental dysplasia. Is it worth it?

Between May 1992 and April 1997, there were 20,452 births in the Blackburn District. In the same period 1107 infants with hip 'at-risk' factors were screened prospectively by ultrasound. We recorded the presence of dislocation and dysplasia detected under the age of six months using Graf's alpha angle. Early dislocation was present in 36 hips (34 dislocatable and 2 irreducible). Of the 36 unstable hips, 30 (83%) were referred as being Ortolani-positive or unstable; 25 (69%) of these had at least one of the risk factors. Only 11 (31%) were identified from the 'at-risk' screening programme alone (0.54 per 1000 live births). Eight cases of 'late' dislocation presented after the age of six months (0.39 per 1000 live births). The overall rate of dislocation was 2.2 per 1000 live births. Only 31% of the dislocated hips belonged to a major 'at-risk' group. Statistical analysis confirmed that the risk factors had a relatively poor predictive value if used as a screening test for dislocation. In infants referred for doubtful clinical instability, one dislocation was detected for every 11 infants screened (95% confidence interval (CI) 8 to 17) whereas in infants referred because of the presence of any of the major 'at-risk' factors the rate was one in 75 (95% CI 42 to 149). Routine ultrasound screening of the 'at-risk' groups on their own is of little value in significantly reducing the rate of 'late' dislocation in DDH, but screening clinically unstable hips alone or associated with 'at-risk' factors has a high rate of detection.

Secondary Calcification of the Planktonic Foraminifer Neogloboquadrina pachyderma as a Climatic Index.

Oscillations in the ratio of two principal types of secondary calcification of the test surface in Neogloboquadrina pachyderma populations closely parallel paleoclimatic oscillations over the last 6 million years in a deep-sea core drilled in the temperate South Pacific. The nature of secondary calcification in fossil planktonic foraminifera represents a useful index in interpreting Cenozoic climates.