Hand problems presenting to a district general hospital accident and emergency department.

An audit was carried out of 1000 consecutive patients presenting with hand problems to a busy district general hospital (DGH), accident and emergency department (A&E). Hand problems accounted for 11% of all A&E presentations. Over 50% of cases were examined radiologically with 37% of these having positive findings. Most patients were male (66%) and manual workers (34%). Only 2.8% of patients required admission, and 50% were discharged with no follow-up. Less than 5% were referred by their general practitioner (GP) and these patients presented during office hours (08.00-18.00 h). The vast majority of the presenting patients could have been treated in a modern, well equipped GP surgery.

Follicular carcinoma of thyroid presenting as back pain leading to a delay in diagnosis.

The case is described of a 53-year-old man presenting with right-sided low back and thigh pain. Non-urgent investigations showed a metastatic lesion in his right hemipelvis arising from a thyroid primary.

GUEPAR total knee prosthesis. Results and outcome of seven years' use in a district general hospital.

Between 1980 and 1987, 44 total knee arthroplasties of the GUEPAR type were performed in 38 patients with severe degenerative joint disease. The patients have been followed up for 7 years and 70% of cases had a good or fair result. The 13 poor results included five cases of deep sepsis, three of whom subsequently underwent successful arthrodesis at this hospital. Other causes of a poor outcome were loosening and patellofemoral dysfunction. Radiological review of 27 knees showed that 80% had lucent lines at either cement/prosthesis or bone/cement interface, although these radiological findings were not associated with clinical evidence of loosening. The major long-term complication was shown to be retropatellar pain, which was recognized in 16% of all cases. However, this would seem to be the only significant long-term complication, and we believe that with the use of a patellar button the GUEPAR prosthesis should continue to be used in selected cases of severe degenerative joint disease.

Entrapment of the tibialis anterior tendon as a cause of nonunion in fractures of the distal tibia.

Three cases of nonunion of a fracture of the distal third of the tibia are reported. The cause of the nonunion in all three cases was the entrapment of the tibialis anterior tendon between the bone ends. This has not been previously reported as a specific cause of nonunion of the distal shaft of the tibia. This paper draws attention to this occurrence as a possible cause of nonunion in this area especially if the fracture is of the oblique type with an anterior spike at the distal end of the proximal fracture, with the line of fracture running parallel to the line of the tendon of the tibialis anterior. We suggest that fractures of this type should be treated early by internal fixation in view of the complications that can occur, such as nonunion, atrophy, or even complete rupture of the tendon of tibialis anterior, leading to a residual equinus deformity.

Superficial radial neuropathy.

Isolated neuropathy of the cutaneous branch of the radial nerve is a rarely recognised condition. Five cases were described in 1932 by Wartenberg, who suggested the name cheiralgia paraesthetica. The condition has also been described as Wartenberg's disease. Twelve cases of isolated neuropathy of the cutaneous branch of the radial nerve are described, the literature is reviewed and the clinical picture outlined. In six of the cases the condition subsided without treatment, in two there was a good response to local injection of hydrocortisone, and in four cases a satisfactory result followed resection of the nerve. The course and distribution of the superficial branch of the radial nerve are described. The need to avoid the nerve during operations around the wrist is stressed.