Early and late results of Brackett's operation for pseudarthrosis of the neck of the femur in infantile coxa vara. A review of 30 operations.

The early and late results of 30 Brackett operations for pseudarthrosis of the neck of the femur are reviewed. The cause of the pseudarthrosis in 28 hips was congenital or infantile coxa vara. The patients' ages at the time of the operation ranged from 2 to 43 years. The early results were good. Only three out of a total of 30 cases failed to unite; 27 hips became stable. Necrosis of the femoral head occurred in six hips. Late results, on average 13 years after the operation, differed greatly from the early results. The majority of the hips were stable but only three completely painless. All but four were affected by secondary osteoarthritis which in six cases was slight.

Lipomembranous polycystic osteodysplasia with progressive dementia.

A rare hereditary syndrome is presented with pathognomonic talar cysts shown on plain radiography and diffuse presenile brain atrophy demonstrated on computed tomography (CT). The main value of CT is related to prognosis and follow-up, as well as to possible genetic counseling.

Intermittent medullary claudication: postmortem spinal angiographic findings in two cases and in six controls.

Postmortem thoracolumbar aortography with solidifying contrast medium to visualize the arteries of the lower part of the spinal cord was performed in two patients with a long history of intermittent neurogenic claudication and degenerative spinal stenosis, as well as in six controls. One of the patients proved to have advanced atheromatous lesions in the aorta, several obliterated intercostal and lumbar arteries, and a blocked caudal portion of the anterior spinal artery. The other had an arterious malformation in the spinal cord at the thoracolumbal junction. The angiographic findings for these patients differed remarkably from those of six age-matched controls, indicating that disturbed blood flow in the lower part of the cord probably contributed to the symptom complex in the patients with claudication. The potential combination of local compression and vascular disease of the cord may explain why decompressive procedures sometimes fail to eliminate a patient's symptoms.

Bicycle accidents often cause disability--an analysis of medical and social consequences of nonfatal bicycle accidents.

Social and medical consequences of 278 children and 264 adults injured in bicycle accidents and seen in two hospitals in Helsinki in 1985-86 were analyzed. Information was collected from patient records, by means of a special questionnaire and by telephone interview. A child outpatient required 1.7 and a child inpatient 3.0 physician visits on an average, while adults required 2.2 and 4.9 visits, respectively. The average duration of hospital stay was 8 days for hospitalized adults and 6 days for children. Rehabilitative care outside the hospital was received by 6% of the adult outpatients and 25% of the inpatients, but none of the injured children. The mean duration of work disability was 82 days among inpatients, 11 days among outpatients, 127 days among the inpatients injured in motor vehicle collisions and 65 days among inpatients injured in other bicycle accidents. Of inpatients 32% and of outpatients 5% reported persistent (> 6 months) disability. Persistent disability was recorded in 11% of children, in 47% of adults and in 67% of elderly inpatients. Most serious consequences were due to intracranial injuries in motor vehicle-bicycle collisions. Of the hospitalized bicyclists 4% suffered from severe cognitive and behavioural changes or sense impairment and of adult inpatients 3% suffered from permanent work disability. The average costs of health and social services were about FIM 1000 per adult outpatient and FIM 13000 per adult inpatient. In prevention high priority should be given to motor vehicle collisions, head injuries and injuries among the elderly bicyclists.

Incidence and characteristics of bicycle injuries by source of information.

Data from analysis of bicycle injuries in a defined, semirural Finnish population were compared with the national hospital discharge register and official police statistics and were related to national data on prevalence of bicycling. The results suggested an incidence of 7.3 injured persons/1000 population, which was 20-fold the figure derived from the police statistics. Inclusion of injuries treated at health centres doubled the number requiring medical attention. Bicycle injuries accounted for 52% of all traffic injuries. A motor vehicle was involved in 11% of bicycle injuries. In these accidents 18% of the victims were hospitalized, but only 6% in other bicycle accidents. Police and hospital records overestimated the proportion of motor vehicle crashes, involvement of elderly persons and incidence of head injuries and fractures. Non-motor vehicle bicycle accidents accounted for most of bicycle injuries, for 58% of in-patients and 93% of out-patients. Information from all levels of health care is required for injury control.