The effects of using a tourniquet during total knee arthroplasty were studied in 80 patients randomly allocated to two groups, either with or without a tourniquet. The groups were similar in mean age, gender, preoperative knee score and radiographic grading and the patients were all operated on by the same surgeon using one type of prosthesis.

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From 1985 to 1988, 90 closed tibial fractures were prospectively studied to assess the morbidity of such injuries to sports people and how this can be influenced by treatment regimens. All fractures were sustained during rugby or football matches. After random selection, 45 fractures were openly reduced and internally fixed (group A), and 45 fractures were manipulated under general anaesthesia and a long-leg plaster applied (group B). For patients in group A, below-knee plasters were used for 3 to 4 weeks, with immediate weight-bearing when tolerated. A total of 44 (98%) tibiae united clinically and radiologically within 14-18 weeks. Within 4 months of surgery 28 (62%) patients had returned to work and were able to play again by the following season. By 6 months 17 (38%) patients had resumed normal activities. In group B, only 24 (53%) tibiae united in a mean time of 16 weeks (range 12-40 weeks). Six (13%) patients required bone grafting for non-union, and one patient subsequently developed osteomyelitis. Only ten (22%) patients were back to work and playing sport again within 6 months of initial injury. It is concluded that internal fixation of closed tibial fractures as a primary procedure following low velocity sports injuries can be safely performed. It leads to a faster return to normal activities with fewer complications than does conservative treatment in plaster using contemporary methods.

The ulnar nerve is vulnerable to compression and vibration injury in drivers who have the shoulder abducted and elbow flexed with the arm lying against the lower edge of the window. Three cases of ulnar neuropathy at the elbow are described in vehicle drivers.

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