Ankle fractures in the elderly: nonoperative or operative treatment.

One hundred consecutive patients over the age of 60 years with unstable fractures of the ankle were retrospectively reviewed. Fifty were treated operatively and 50 nonoperatively. The mean follow-up was 7 years (2-16 years). Satisfactory reduction was a prerequisite in both groups. Patient satisfaction with regard to pain, deformity, and stability was significantly better in the operated group. The high proportion of poor final results in the nonoperatively treated group correlated well with malunion and nonunion.

Axillary block anaesthesia in acute and elective hand surgery: a report on 300 procedures.

A total of 300 consecutive anaesthetic axillary blocks was performed over a period of 18 months in 291 patients. These blocks were carried out for emergency and elective hand surgery. Patients did not require any preparation or starving; 20-30 ml of 1% prilocaine according to the size of the patient is used for the block. A minimum induction time of 45 min is needed and patients are able to leave the hospital 20 min-2 h after operation, depending on the nature of the operation. No operation had to be abandoned due to failure of the block. Eleven patients required further injection of local anaesthetic during the operation. The duration of operations ranged from 10 to 130 min. Only 20% needed postoperative analgesia. The technique is easy to perform, it is safe and has long-lasting analgesic effect. It is an efficient, economical method of treatment, well tolerated and often preferred by patients. We think axillary block anaesthesia should be more generally used in hand and orthopaedic units.

Arthrodesis of the shoulder following brachial plexus injury.

A series of 13 arthrodeses of the shoulder in adults with brachial plexus injuries have been reviewed. Using internal fixation and external splintage we aimed at a final position of 30 degrees abduction, 30 degrees flexion and 20 degrees of internal rotation. Patients were followed up for between 24 and 60 months. In only one was bony union not achieved, although the resulting fibrous union was asymptomatic. All patients had additional procedures including plexus exploration in six, Steindler procedure in two, triceps to biceps transfer in two, latissimus dorsi transfer in two, and above-elbow amputation in three. All patients stated that shoulder fusion had improved the function of their limb. Minimum range of movement was 50 degrees abduction and 40 degrees flexion. Two patients continued to complain of pain despite solid fusions. Compression arthrodesis of the shoulder is an effective method of achieving fusion and reliably improves the function in adults with brachial plexus injury.

An arthroscopic technique of demonstrating the pathomechanics of the suprapatellar plica.

The suprapatellar plica or incomplete suprapatellar septum of the knee is a recognized cause of knee pain in some patients and appears to exist in others without causing any symptoms. To date no clear method of demonstrating the pathomechanics of the suprapatellar plica by arthroscopic means has been described. This article describes a new technique of visualizing this structure arthroscopically and demonstrating the mechanism of its morbidity. By the use of a proximal viewpoint via the lateral suprapatellar portal, we have shown that the suprapatellar plica impinges on the medial femoral condyle and is trapped between the quadriceps mechanism and the femoral trochlea when the knee is flexed beyond 70 degrees. We conclude that our arthroscopic method may show the mechanism of production of symptoms of the pathological suprapatellar plica.