Injury
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An effective method for reducing anterior dislocation of the glenohumeral joint which does not require either sedation or traction is described. The patient performs the manoeuvre. ⋯ Easy reduction was achieved in 72 per cent, with no complications and patients spent less than half as long in the accident and emergency department as when it is not successful. We recommend this simple technique as a first method of reduction in patients presenting to accident and emergency departments.
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A total of 717 fractures and fracture-dislocations of the cervical spine occurred in 657 patients in a 13-year period. Injury was commonest in the third decade of life. The levels most frequently injured were the second, fifth, and sixth. ⋯ Odontoid fractures were the most frequent fractures in patients over 70 years of age, and formed the majority of fractures in patients over 80 years of age. It is recommended that if a fracture of the upper cervical spine is seen on radiographs, another fracture in the upper or lower cervical spine should be excluded. Patients aged 70 years and above who complain of neck pain after trauma should be suspected of having an odontoid fracture, until proven otherwise.
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The treatment of ipsilateral supracondylar fractures of the humerus and fractures of the forearm bones was evaluated in 11 children. After an average of 6 years, 10 children had excellent or good results and one had a poor result from Volkmann's ischaemic contracture. Displaced supracondylar fractures of the humerus associated with distal fractures of the forearm bones are best treated by closed reduction and percutaneous pin fixation of the humeral fracture and a below-elbow plaster backslab.
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Eight records used in six accident and emergency (A/E) departments in the Mersey Region were reviewed. We studied (1) the structure of records; (2) the printed matter on the record; (3) the designated areas for documentation by the administrative, nursing and medical staff; and (4) the advantages of the records in transferring information to other departments and general practitioners. The use of computers in the departments was investigated. ⋯ None of the accident and emergency departments used computers for either delayed or real-time recording of patients' details. A computer-structured A/E Record will produce a legible, factual patient history, examination and care plan. The information recorded will be easily transferred to relevant hospital departments and ultimately to the community practitioners.
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Anatomical reduction and internal fixation of displaced lateral malleolar fractures are the cornerstone of the operative treatment of ankle fractures. The classical method of fixation is the application of one-third tubular plates laterally to the distal fibula, a technique, however, that has several disadvantages. In exceptional cases and under special circumstances we prefer a dorsal approach with the use of an antiglide plate. Indications, technique and experiences are discussed.