Injury
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Four cases of unstable fracture-dislocation of the fifth carpometacarpal joint are reproted, including 3 isolated dorsal fracture-dislocation and 1 dorsal fracture-dislocation associated with a fracture of the fourth metacarpal bone. All cases required open reduction and Kirschner wire fixation which resulted in good function. Attention is drawn to the frequent delay in diagnosis. The applied anatomy is discussed.
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This paper reports a study of 266 patients who were admitted to an Accident Service after being involved in road traffic accidents during the four-month period from February to May in 1976. There were 216 front-seat occupants, of whom 21 per cent were wearing seat belts: 156 patients were treated as outpatients and 105 patients were admitted to the wards. ⋯ There was an 11 per cent increase in the use of seat belts compared with a similar study carried out in 1971 and random roadside surveys also showed a 10 per cent increase. The implications of these findings are discussed.
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This paper reports a study of ipsilateral fractures of the femoral and tibial shafts in 21 patients treated according to a detailed plan including shock treatment, prophylaxis against fat embolism, soft-tissue and fracture treatment. Death due to hypovalaemic shock was eliminated and the incidence of fat emboliism (9-5%) reduced in comparison with an earlier series. ⋯ Results have improved compared with earlier series. All fractures healed within 15 months, and functional end results have been excellent in the majority of the surviving patients (89%).
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Comparative Study
A conservative approach to penetrating injuries of the chest. Experience with 131 successive cases.
One hundred and thirty-one cases of penetrating injuries of the chest were reviewed prospectively. A policy of conservative management is advocated, based on the intercostal drainage of moderate or large collections of fluid and/or air. The site of the intercostal drain is not an important factor in the management.
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Five patients with blast injuries to the lungs after bomb explosions are reported. In each patient radiological changes were apparent on the initial chest film taken within 4 hours of the explosions. Arterial hypoxaemia was also present. ⋯ Two patients died, one owing to bilateral pneumothorax which occurred during anaesthesia, and the other owing to overwhelming infection. Hypoxaemia persisted for 4 months in one of the survivors. Lung function tests which were performed on the same patient 10 monhts after the blast injuries, however, were normal.