A simple clinical test of flexor pollicis longus rupture.

Rupture of the tendon of flexor pollicis longus is suspected when active flexion of the interphalangeal joint of the thumb is not possible. This can be a result of trauma but, when spontaneous, diagnostic confusion can exist as incomplete palsy of the anterior interosseous nerve can present in a similar way. We describe a simple clinical sign which can differentiate between these conditions.

Parachuting injuries during training descents.

An analysis of the injuries sustained during a series of 51,828 military training parachute descents and which were treated at the John Radcliffe Hospital is presented. The significant casualty rate was 0.22 in every 100 descents. There were 4 deaths, 5 multiple injuries and 104 single fractures, dislocations or head injuries. The injury rate is lower than that reported for training descents made by sports parachutists, despite more difficult conditions. Serious injuries and deaths were often the consequence of interactions between two jumpers.

Post-concussional symptoms following minor head injury.

The effect of admission to hospital after a minor head injury on the incidence and duration of post-concussional symptoms was investigated. A total of 114 adults with a minor head injury were randomly allocated to admission for 24 h or to discharge from the accident department. Follow-up was by postal questionnaire. This revealed that 90 per cent of patients suffered symptoms lasting an average of 2 weeks. The patients who were discharged had symptoms that lasted a shorter time. Admission to hospital does not reduce the incidence and severity of symptoms following minor head injuries in adults.

Technical considerations of the AO interlocking nail.

We report 23 patients treated with 24 AO femoral intramedullary locked nails performed at the John Radcliffe Hospital, Oxford. There were no major complications and all 17 acute traumatic fractures followed up for longer than 4 months proceeded to an uncomplicated union, with an excellent range of knee movement.

Laser Doppler monitoring of replants using a small prism probe.

Eighteen patients admitted to Duke University Medical Center for upper limb replantation or revascularization were studied. A small laser Doppler flow prism probe and a cutaneous temperature probe were attached to the distal pulp of replanted digits. Measurements were recorded hourly for the first 3 postoperative days. In the successful cases, the mean laser Doppler flow measurement was 1.76 units (lower 97% confidence limit 0.5 units) and the mean temperature was 34.1 degrees C (lower 97% confidence limit 32 degrees C). In 4 patients with vascular compromise, the laser Doppler flow correctly identified the problem. The reduced size of the new laser Doppler probe makes monitoring of distal pulp flow technically easier while maintaining accuracy.

An improved method of recording rat tracks for measurement of the sciatic functional index of de Medinaceli.

The use of paper impregnated with Bromphenol blue for recording normal rat footprints is described. Because paper provides a better grip than X-ray film for the paws of the rats, the resulting tracks make manual scoring easier and more accurate. In addition, the cost of this technique is considerably lower.

The risks of injury in public ice skating.

A prospective survey has been made of the injuries to members of the public attending a well established ice rink in a major city. Comparison is made with series in the literature reporting high levels of injuries, with corresponding demands on local hospital services, from newly established ice rinks. The main conclusion is that demands on hospital services have been markedly reduced for the well established rink, with corresponding savings in health service resources.

The wraparound procedure for thumb and finger reconstruction.

Nineteen thumb and finger reconstructions were performed using the wraparound procedure; there were five early arterial failures. Thirteen of the 14 successful digital reconstructions were reviewed at an average of 26 months after surgery. There were complications related to the upper limb in seven patients, several of whom had more than one problem; these included radial skin breakdown (2), malrotation (2), and infection (2). One patient underwent late deletion for chronic infection following corrective osteotomy. Time until toe donor site healing averaged 2 months. We considered that cosmesis and function were good. Pinch grip averaged 48% of normal; sensibility returned in all patients--four regained protective sensation and the others attained two-point discrimination (average 9 mm). The wraparound procedure provides a cosmetically and functionally excellent method of thumb reconstruction for amputation distal to the metacarpophalangeal joint.

Fractures of the metacarpal neck of the little finger.

A prospective study of 73 patients with fractures of the metacarpal neck of the little finger is reported. Fifty-seven (78 per cent) of the patients were followed up between 1 and 2 years after the injury. Forty-three (75 per cent) of these patients complained of symptoms, though only one patient considered himself disabled. The normal head/shaft angle at the fifth metacarpal neck measured in 12 control subjects as viewed on an oblique radiograph was 26 degrees. The importance of allowing for this normal angulation when assessing the angulation at the fracture is discussed. After manipulation, the corrected position of the fracture is not adequately maintained by a volar plaster slab. No definite relationship between the presence of symptoms and the residual angulation at the fracture site was demonstrated. Manipulation of these fractures is thus seldom indicated.

Ice-skating injuries.

The range of injuries sustained at an ice-rink and presented to an Accident Service department is described. A total of 203 patients with 222 injuries presented themselves during a 2-month period. There were 103 noteworthy injuries, including 61 fractures, 2 dislocations and 2 severed tendons, but the commonest injuries were wounds, sprains and bruises. Beginners appear to be more prone to injury than experienced skaters. In addition to using well-fitting skate-boots to protect the ankle, some injuries could be avoided by wearing elbow and knee pads, and a thick pair of gloves. The number of injuries compared with the total number of skaters was small but produced a noteworthy increase in the workload of the Accident Service.

Recurrent dorsal trans-scaphoid perilunate dislocation.

A case is presented in which trans-scaphoid perilunate dislocation occurred through a scaphoid non-union. The place of open reduction and immediate bone grafting is discussed.

The role of prophylactic antibiotics in appendectomy using delayed primary closure.

A prospective randomized trial of prophylactic antibiotics in 202 patients undergoing appendectomy is reported upon. The antibiotics used were metronidazole and cephradine. Half of the patients received antibiotics preoperatively. The other half received antibiotics at operation only upon finding perforation, gangrene or pus formation. All wounds were treated by delayed primary closure. No instance of wound infection, defined as abscess formation or cellulitis, occurred in either group. Antibiotics given prophylactically in every instance appear to have no advantage in preventing wound infection when delayed primary closure is used.

Stapling instruments in upper gastrointestinal surgery: a retrospective study of 362 cases.

A retrospective review of 362 upper gastrointestinal operations performed over a 6-year period was undertaken. The incidences of complications following the use of stapling instruments (Autosuture) or the use of conventional anastomotic techniques were compared. Complications considered to be related to anastomotic techniques were: leak or bleeding from the suture line or the development of intra-abdominal or wound sepsis. The complication rates were 21 per cent for operations using conventional suturing techniques and 16 per cent for operations in which the stapling instruments were employed.