A technique of dynamic reduction for displaced fractures of the thalamus of the calcaneum.

A new technique of reduction based on the anatomical structure of the calcaneum was first described in 1974. Two pins were inserted, one into the posterior surface and the other into the plantar surface of the bone. This allowed early mobilisation of the foot. The method can be used in all types of fractures including comminuted fractures of the tuberosity, the tongue type, the central depression type, the severe tongue type, the severe depression type and unclassified severe crush fractures. Complete anatomical reduction was obtained in 58 out of 72 fractures (77%) and 56 out of 64 patients (87.5%) were classified as "very good" by the Maxfield assessment. In this paper the authors discuss their method of management of displaced fractures of the thalamic part of the calcaneum.

Enflurane-induced hypotension modifies transmural blood flow distribution in the canine left ventricle.

Coronary and systemic circulations, and contractility and oxygen consumption of the left ventricular myocardium were depressed as arterial enflurane concentration increased in acute experiments with 22 adult mongrel dogs. Uneven transmural blood flow in the left ventricular free wall did not appear and the inner/outer ratio remained near 1.0 until a very deep stage of the anesthesia was attained and as far as diastolic aortic pressure was maintained above 40 mmHg, according to the microsphere injection study. Once diastolic pressure fell below 35--40 mmHg, the ratios started to be reduced significantly. When arterial enflurane content reached 53.0 +/- 2.1 mg/100 ml (mean +/- s.e.), the ratio became 0.84 +/- 0.08 (p less than 0.001), and simultaneously calculated DPTI/TTI ratio also showed a significant redution from the control (0.79 +/- 0.03, p less than 0.001). The I/O and DPTI/TTI ratios, however, did not correlate significantly with each other until very deep enflurane anesthesia was attained. The lower limit of autoregulation of coronary vascular bed was suggested to be near 35--40 mmHg of diastolic aortic pressure during deep enflurane anesthesia in the dog. Among systolic time intervals measured directly during the study, PEP and ICT showed significant negative correlations with Vmax and LV dp/dt max, while LVET neither changed nor correlated significantly with stroke volume or other parameters representing myocardial contractility during the course of enflurane anesthesia.