Foam slipper in place of the walking heel for lower limb plaster of Paris casts.

Avoidable delays in the application of weight-bearing lower limb plaster of Paris casts on our patients caused by shortages of the standard walking heels (rockers) made us try the common and always--available foam slippers in their place. Their use in the treatment of 450 patients is reported here. The slippers performed all the usual functions of the rockers well and there were no complications due to their use. The patients felt very steady and comfortable on them and particularly appreciated the cushioning effect of their soft soles and the fact that they could use the other slipper on the uninjured leg comfortably. On the basis of the excellent results obtained in this study and in view of their cheapness and ready availability, the author recommends a wider use of slippers in place of the conventional rockers.

Familial hyperphosphatasaemia in a Nigerian child.

A 5-year-old Nigerian girl of normal intelligence had grotesque crippling skeletal deformities, multiple pathological fractures and dwarfism dating back to the end of the first year of life. She also suffered from recurrent lower respiratory tract infection since infancy. The clinical, biochemical and radiological profile were compatible with the diagnosis of familial hyperphosphatasaemia.

Avascular necrosis of the femoral head in sickle-cell disease. A series from the Guinea Savannah of Nigeria.

Of 899 patients with sickle-cell disease, aged between 6 and 28 years, who attended clinics in the Guinea Savannah of Nigeria in 1982 and 1983, 29 had symptoms of avascular necrosis of the femoral head. This group was studied in detail. Twenty-eight patients had haemoglobin-SS electrophoretic patterns and one had haemoglobin-SC. The male to female ratio was 1 to 1.6, and most of the patients were aged between 6 and 15 years at the onset of hip symptoms. These symptoms correlated with the radiographic lesions, but were not related to the age or sex of the patient. The radiographic lesions varied widely and were related to the age at onset of hip symptoms. A new radiological classification is proposed.

Preliminary results of treatment of fractures of the femur by cast-bracing using the Zaria metal hinge.

This is a prospective study of 27 patients with fractures of the femur at different levels and treated by cast-bracing using the Zaria hinge. The shortest follow-up period is 6 months. The brace was applied after an average of 4.5 weeks in traction. No alignment jigs or other accessory appliances were used. The patients got up 1-3 days after application of the brace and left hospital 5.8 weeks after fracture. Healing of the fracture was judged clinically and radiologically. The patients were pleased with the method. The average time in the brace was 9 weeks and to clinical union was 13.5 weeks. Three patients had shortening of more than 2.5 cm and six fractures were bent by more than 10 degrees but most of these deformities were present before the brace was applied. When the brace was removed the average range of flexion at the knee was 0-80 degrees and 6 months after fracture it was virtually full. The only notable difficulty with the hinge was loosening of the proximal end-plate. It is concluded that the Zaria metal hinge is an effective device for the cast-bracing of fractures of the femur, that alignment jigs and other accessory appliances are not essential for its application and that the cast-brace method is particularly suitable for use in the developing countries because of its effectiveness, simplicity and cheapness.

Ipsilateral fracture of the head and neck of femur with partial fusion to the acetabulum.

A fracture of the head and neck of the right femur in a 50-year-old man was complicated by fusion of a large portion of one head fragment to the acetabulum as a result of prolonged walking on the fractured hip. This unexpected complication made management difficult as facilities for a total hip replacement were not immediately available.

Traumatic paraplegia in Zaria, Nigeria: the case for a centre for injuries of the spine.

This is a review of 48 patients with traumatic paraplegia treated at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria in the period June 1973 to June 1982. The records are unfortunately incomplete. All but three of the patients were treated conservatively. The mean hospital stay was 3 months. Facilities for adequate management including rehabilitation were lacking. Twelve patients (25 per cent) died within 10 weeks of admission, 30 developed bed sores and all had urinary tract infection beginning whilst in hospital. Wheelchairs could not be provided by the hospital for those who did not recover motor function and most of the patients could not afford to buy them. Most of the patients treated earlier in the series were lost to follow up. In the last 12 months of the period under review, 15 patients were treated using much the same facilities as existed in previous years. There was no hospital mortality during this period, and although urinary tract infection could not be prevented, only two of the patients (13 per cent) developed bed sores. It is suggested that the establishment of a Centre for Injuries of the Spine, with the direct involvement of the Government through the Ministry of Social Welfare, in the management of these patients will definitely improve the overall results.

Difficulties and complications of the Ender method of treatment of trochanteric fractures of the femur.

The advantages of the Ender technique over the other methods of treatment of trochanteric fractures of the femur have been emphasized by several authors but the difficulties and complications of the method have perhaps not been sufficiently highlighted. With this imbalance in mind, 60 patients treated by the Ender method have been reviewed with particular emphasis on the problems encountered during treatment. The follow-up period ranges from 6 to 28 months. The main technical difficulties were experienced during the reduction and nailing of the comminuted and displaced fracture. The main postoperative complications were the cutting out of the nails from the head and neck fragment with weight bearing, backing down of the nails at the knee, and external rotation deformity. The early mortality, infection, delayed union and non-union rates were low.

An unusual combination of fractures at the wrist.

A rare fracture involving the distal ends of the radius and ulna and three carpal bones is described. A possible mechanism of injury is suggested.