Folded free vascularized fibula transfer.

A technique of improved free vascularized fibula grafting for bone defects up to 15 cm in length is presented with three illustrative cases. By dividing a harvested free fibula graft at its midpoint without dividing its vascular pedicle, two vascularized bone lengths are produced that require only one set of anastomoses. This folded fibula provides twice the cross-sectional area of a single fibula transfer and allows biomechanically improved graft placement. This technique has been successfully used in long bone defects of the upper and lower limbs.

Medical significance of occupant restraint on road-crash victims and the role of the medical profession.

Compulsory use of seat belts has been the single most important measure in reducing the number of deaths and injuries on the road. Seat belts are most effective in reducing head and facial injuries in frontal impacts, but less so with side collisions and roll-overs. There should be no medical exemptions to the wearing of seat belts. There is little evidence that seat belts, if properly worn, cause serious injury. The reduction in road deaths and injuries applies only to car occupants: the number of deaths in motorcyclists closely parallels the number of motorcycles in use. Likewise, the pedestrian death rate remains unchanged.

Cortical bone grafts with muscle pedicles. An experimental study of survival and ability to bridge a bone gap.

A cortical bone graft on a muscle pedicle was taken from the ulna and transferred to bridge a complete defect of the radius in 16 dogs. In 14 control dogs a free graft was used, that is, one without a muscle pedicle. Union in the group with pedicle grafts was far superior to that in the group with free grafts, mainly because in those with pedicle grafts there was good subperiosteal new bone formation from active viable periosteum. In six of the pedicle grafts the viability of some osteocytes was retained over a 12-week period and in five the graft was almost completely replaced by new bone.

Total hip replacement combined with bone grafting for acetabular dysplasia causing severe osteoarthritis of the hip joint.

Over a 10 year period 18 total hip joint arthroplasties (THJA) were performed on 15 patients with disabling osteoarthritis of the hip joint secondary to congenital dislocation or subluxation. In all cases reconstruction of the deficient acetabulum was necessary in order to provide total bony containment of the acetabular prosthesis. This was achieved using a bone graft, fashioned from the femoral head and securing it above the true acetabulum. At follow-up all patients were pain free. Radiographically, there had been no loosening of the acetabular prosthesis and all grafts appear to have united. The operative technique is described in detail.

Subcutaneous rupture of the tendon of tibialis anterior.

Subcutaneous rupture of the tendon of tibialis anterior immediately proximal to its insertion affects patients over the age of 45 years and is most common in the seventh decade. The symptoms at the time of rupture are milder than is the case with rupture of the calcaneal tendon and the early disability is slight. Thus, affected patients commonly present several weeks or months after rupture and at a stage when reattachment of the tendon to its normal site of insertion (the most satisfactory surgical management) is impossible. Although the disability is slight if repair is not performed, there should be no disability after surgical repair and this should be offered to those patients who lead an active life and who present in the first three months after rupture. The relevant literature is reviewed and experience with four further patients is recounted.

The pattern of motor cycle injuries sustained by motor cyclists in Victoria in 1974 and 1975.

Motor cycle injuries and fatalities (2.4% annually) represent a serious threat to the youth of Australia. This survey outlines the pattern of injuries sustained by motor cyclists and highlights of the high percentage (73%) of serious local injuries to the lower extremities. The views of motor cyclist victims on preventive safety measures are also summarized.

Antibiotics in the management of postoperative disc space infections.

The place of antibiotics in the management of postoperative disc space infections is examined on the basis of a review of 14 cases. Whereas the role of antibiotics is clear in acute infections which manifest themselves in the early postoperative period, this is not so for cases which present late with a chronic process. Here, immobilization in a double hip spica is the single therapeutic measure recommended.

The effects of seat belt legislation on road traffic injuries.

The compulsory wearing of seat belts, first introduced in the world in Victoria in 1970, has effectively reduced the number of deaths and injuries by approximately one-third for car occupants involved in motor vehicle crashes. Initially, the legislation did not apply to children under the age of eight years, but in 1975 a further law was introduced banning children from the front seat of any vehicle unless properly harnessed. Seat belts offer the best protection for front seat drivers and passengers involved in frontal impacts, but offer less protection to the recipient of a side impact. Ten per cent of car occupants admitted to hospital after a frontal impact show injuries, mostly minor, directly attibutable to the wearing of seat belts.

Benign osteoblastoma.

Benign osteoblastoma is a benign bone-forming lesion, seen most commonly in the first three decades of life and having a predilection for the vertebral column and the short limb bones. It is distinguishable from osteoid osteoma on the bases of size (being more than one centimetre in diameter) and the absence of surrounding sclerosis. The two lesions, however, are probably of the same origin and behave differently because of their different situations. Treatment is by operation, either excision in whole if practicable, or thorough piecemeal excision and curettage, with bone grafting of the defect if indicated.

The effects of mandatory seat belt wearing on the mortality and pattern of injury of car occupants involved in motor vehicle crashes in Victoria.

Compulsory seat belt wearing, first introduced in the world in Victoria in 1970, has effectively reduced the number of deaths and injuries for car occupants involved in motor vehicle crashes, whilst those for the unprotected pedestrian and pedal and motor cyclist have continued to increase. This legislation does not apply to children under the age of eight years, only 5.5% of whom travel restrained in motor cars, and their death and injury patterns remain unchanged. Seat belts offer the most remarkable protection for car occupants involved in frontal-impact collisions. However, a high percentage of car occupants who are the recipients of a side impact in a collision receive serious multiple injuries, particularly chest and pelvic injuries, and seat belts offer little protection except that head injuries are less common when a seat belt is being worn. Compulsory lateral strengthening of motor vehicles must be introduced in Australia. Ten per cent of car occupants admitted to hospital after frontal-impact collisions show injuries directly attributable to the wearing of seat belts. These include fracture of the clavicle, bruising and fracture of the sternum, cardiac tamponade, abdominal contusions and bowel lacerations. Seat belts, to be fully effective, must be fitted correctly. There is definite room for improvement in seat belt design.