Skiing injuries: the increasing workload.

All skiing injuries presenting to a fracture clinic during the period December 1992 to April 1993 were studied. Fifty five patients with 59 injuries were treated during this period. Thirty (54.5%) were male and 25 (45.5%) female. The mean age was 34 years (range 9-61). The anatomical distribution of injuries seen corresponded very closely with those seen in much larger studies abroad. There were 35 upper limb injuries (59.3%), 22 lower limb injuries (37.3%), with only two spine and trunk injuries (3.4%). While only two patients underwent surgery abroad, a further 12 needed surgical intervention on return, requiring a total stay of 61 'inpatient days'. The bulk of the workload was, however, on an outpatient basis, with a total of 172 appointments. Many advances have been made towards improving the safety of skiing. However with skiing becoming increasingly popular we can expect an increasing workload and cost associated with such injuries.

Poor results of the Ribbed Hip System for cementless replacement.

We reviewed 12 patients six years after they had undergone total hip replacement with a cementless prosthesis, the Ribbed Hip System (Waldemar Link GmbH & Co, Hamburg, Germany). Aseptic loosening of one or both components had necessitated revision surgery in seven patients, in five within two years of operation. In view of our experience we question the wisdom of allowing the uncontrolled use of new prosthesis without postoperative surveillance.

Distal fibulectomy for Ewing's sarcoma.

We treated five children with non-metastatic Ewing's sarcoma of the distal fibula by distal fibulectomy. At a mean of eight years after surgery they all had nearly normal levels of painfree function. Distal fibulectomy is a good alternative to the more radical amputations recommended in the past.

An audit of the effect of a 24-hour emergency operating theatre in a district general hospital.

The recent introduction of a 24-hour emergency theatre for General Surgery provided an opportunity to audit its effect on emergency operating in a District General Hospital. Prior to its introduction much of the emergency operating was determined by theatre availability rather than clinical need. Half of the emergency operations were carried out between 10 pm and 8 am. This proportion was reduced to a third when a theatre was continually available. This had benefits for the patients in reducing their waiting time and also for the junior surgeons by increasing their sleep. A survey of the Region indicated that very few hospitals provided adequate emergency theatre facilities.

The injured motor cycle messenger.

Injured motor cycle messengers make up a small but significant proportion of the young injured attending Central London accident and emergency (A&E) departments. The study confirms that the pattern of their injuries is similar to other injured urban motor cyclists, and discusses the background of the injured, in terms of experience and training, highlighting the frequency of injury and possible predisposing factors. A total of 116 injured motor cycle messengers attending two Central London A&E departments over a 10-month period were studied. Thirteen per cent sustained sufficiently serious injuries to necessitate admission, the rest were treated as out-patients for lesser injuries. The mean age was 23. Only 18% had received any formal training and 31% were in possession of a provisional driving license only. Fifty-eight per cent had been employed as a messenger for less than 3 months, yet two-thirds of them had sustained a previous injury whilst a messenger. The apparent absence of supervision of this potentially dangerous occupation is emphasized. In view of the repeated injuries sustained by many of these vulnerable young men, it is suggested that those responsible for their treatment might, in addition to their therapeutic role, give suitable guidance that might prevent re-attendance with further injuries.