Conservative management of wrist ganglia. Aspiration versus steroid infiltration.

Wrist ganglia were randomly allocated for conservative treatment by either aspiration or aspiration and injection of steroid. Both treatment methods had 33% success rates. Almost all ganglia which recurred after one aspiration did not resolve with further aspirations. After aspiration and explanation of the benign nature of ganglia, only a quarter of patients requested surgical treatment.

Wound drains in proximal femoral fracture surgery: a randomized prospective trial of 177 patients.

We report on a prospective randomized trial on the effect of wound drains on wound healing following surgery for proximal femoral fractures. One hundred and seventy-seven consecutive patients admitted to Queen's Medical Centre Nottingham, undergoing AO dynamic hip screw (DHS) or hemiarthroplasty were randomized whether or not to receive wound drainage. Wound healing was assessed in terms of ultrasound examination, the ASEPSIS wound score system and overt infection rates. All patients were followed up at 6 weeks and 6 months. Ultrasound examinations showed that drains were indeed ineffective in preventing haematoma formation, the first time this has been demonstrated objectively. However, using drains failed to prevent late seroma formation. Patients who received wound drainage showed statistically better wound healing on the ASEPSIS wound scoring system and a reduced infection rate. The ASEPSIS scores on day 2 and 5 postoperatively proved an accurate predictor of poor wound healing. This study conflicts with previous smaller studies which failed to show an effect of wound drainage upon wound healing, and strongly supports the use of wound drains.

The Seidel locking humeral nail: the Nottingham experience.

The experience of one institution in the use of the Seidel locking intramedullary nail in 23 patients with humeral shaft fractures is reported. The device was used only for cases involving failure of previous treatment, pathological fractures or multiple injuries. Acceptable results were achieved in patients with pathological fractures, but the results in other patients were disappointing with unacceptably high complication rates and poor postoperative shoulder function.

Wound drains in proximal femoral fracture surgery: a randomized prospective trial of 177 patients.

We report on the effect of wound drains on wound healing following surgery for proximal femoral fractures. One hundred and seventy-seven patients undergoing AO dynamic hip screw (DHS) or hemiarthroplasty were randomized whether or not to receive wound drainage. Patients who received wound drainage showed statistically better wound healing in terms of the ASEPSIS wound scoring system and a reduced infection rate. This study conflicts with previous smaller studies which failed to show an effect of wound drainage upon wound healing.

Excision of the trapezium for osteoarthritis at the base of the thumb.

We have assessed the results of 34 simple excisions of the trapezium, with no additional soft-tissue procedures, in 30 patients. At a median follow-up of five years (2 to 22), 16 thumbs (47%) were completely painfree and a further 10 (29%) were slightly painful after use. Nineteen thumbs (56%) had no functional disability, but thumb-pinch strength was reduced by about 20%. No patient had painful degeneration at the scaphotrapezial pseudarthrosis.

Ultrasound assessment of the efficacy of wound drains.

We report the use of ultrasound in the assessment of the efficacy of wound drains in preventing wound haematoma. 171 patients with proximal femoral fractures who underwent AO dynamic hip screw or hemiarthroplasty were randomized as to whether or not they should receive wound drainage. Patients then underwent ultrasound examination on the 5th postoperative day to localize and quantify any wound haematomas. Results show that drains are effective in preventing wound collections, but only while in situ; following the removal of drains the size of resulting wound collections is the same whether the wound has been drained or not (Student's t-test; t = 0.19, NS). This study questions current theories on the mechanisms by which wound drainage is thought to influence wound healing.

Injury patterns in motorcycle road racers: experience on the Isle of Man 1989-1991.

We report the first prospective study on the incidence of motorcycle accidents of the world's foremost motorcycle road-racing venue, the Isle of Man. Between 1989 and 1991 there were six meetings during which over 2500 riders took part. Racing on essentially normal country and town roads, the motorcycles can reach speeds in excess of 306 km/h and the average lap record is now 198 km/h. During the study, 175 motorcyclists were injured and 16 were killed (9.1 per cent). The most common injury patterns were soft tissue injury (114 riders), head injury (52) and fractures/dislocations (188), of which one-third were open. The injuries sustained were more frequent and of a greater severity than recreational motorcycling. The casualty rate was 15 times, and the fatality rate 87 times the national figures. Of the 16 fatalities only seven reached hospital alive, despite the use of helicopter air ambulance, and 14 had serious head injuries. No fatality was thought to have been avoidable on review. There were no cervical spine injuries and only two major abdominal injuries. Of the injured riders, 93 (56 per cent) were admitted and there were 170 surgical procedures undertaken on 54 riders.

Helicopter transfer of trauma patients: the Isle of Man experience.

A 10-year study of the helicopter transfer of motorcyclists injured during the International Motorcycle Tourist Trophy races (TT) and the amateur Manx Grand Prix (MGP) is reported. A total of 266 riders was transferred from the scene of the accident to hospital by air. The overall mortality rate for those riders airlifted was 3.38 per cent. The figures are compared with similar emergency helicopter services.