Annals of the Royal College of Surgeons of England
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Ann R Coll Surg Engl · Jan 1995
Bicyclist head injury prevention by helmets and mandatory wearing legislation in Victoria, Australia.
After a decade of promotion and education, legislation for mandatory helmet wearing by bicyclists in Victoria was introduced on 1 July 1990. The legislation was a world first. ⋯ Legislation for mandatory helmet wearing in Victoria has led to increased wearing rates and marked reductions in bicyclist fatalities and head injuries. The Victorian experience gives substantial support to the introduction of legislation for mandatory helmet wearing by bicyclists.
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Ann R Coll Surg Engl · Jan 1995
Neurological complications of high tibial osteotomy--the fibular osteotomy as a causative factor: a clinical and anatomical study.
A clinical study of 105 upper tibial osteotomies was undertaken to investigate the incidence, pathology and outcome of perioperative neurological deficit. Motor weakness and/or sensory deficit occurred in 21 patients (20%) and in half of these the deficit was permanent. ⋯ An anatomical explanation is proposed for this complication, based on cadaveric studies. Due to unacceptably high levels of complications it is recommended that the fibular osteotomy should not be performed in zones II and III (from just below the fibular head to 15 cm distal to this level).
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Ann R Coll Surg Engl · Sep 1994
Clinical Trial Controlled Clinical TrialPrevention of phantom pain after major lower limb amputation by epidural infusion of diamorphine, clonidine and bupivacaine.
Phantom limb pain may appear in up to 85% of patients after amputation. There is no effective treatment. Perioperative epidural infusion of morphine and bupivacaine, alone or in combination, is effective in preventing phantom limb pain in patients with pre-existing limb pain. ⋯ At 1 year follow-up, one patient in the study group and eight patients in the control group had phantom pain (P < 0.002) and two patients in the study group versus eight patients in the control group had phantom limb sensation (P < 0.05). There was no significant improvement in stump pain. We conclude that perioperative epidural infusion of diamorphine, clonidine and bupivacaine is safe and effective in reducing the incidence of phantom pain after amputation.