Orthopaedic dictum teaches that fractures oflong bones, when associated with head injuries, frequently heal with excessive callus and at a faster rate than normal. The evidence, however, is flimsy and based on small series of patients treated in different ways and never with an adequate control series (Calandriello 1964). The dictum remains unsubstantiated and, indeed, Garland failed to confirm increased callus formation or more rapid healing of fractures of the tibia and femur in patients with head injuries (Garland and Toder 1980;Garland, Rothi and Waters 1982). These series, however, had no controls, nor did they quantify the callus.The conservative treatment of fractures in patients with head injuries is made more difficult for both medical and nursing staff by the fact that patients are often unable to co-operate. Excessive callus in these patients may then be due to lack of control of the limb and excessive movement at the fracture, and only indirectly to the head injury. In order to eliminate these variables, we decided to study fractures ofthe shaft of the femur treated by AO nailing and to measure and compare the extent of callus production and the rate of healing in patients with or without associated head injury. PATIENTS AND METHODSThe series reviewed comprised 22 consecutive patients Requests for reprints should be sent to Mr A P Skirving.©1987British Editorial Societyof Bone and Joint Surgery 0301â€"620X/87/4098 $2.00 severity of the head injury was graded : mild â€" in a coma for less than 3 hours ; moderate â€" a coma lasting 3 hours to 3 days ; or severe â€" a coma lasting more than 3 days. Fourteen of the 22 patients had a severe head injury, the period of coma varying from 3 to 41 days (average 15 days). Twenty-two consecutive patients without head injury but with similar femoral fractures treated with AO intramedullary nails formed the control group (Group II) and 11 of these patients had additional severe orthopae dic injuries.The fractures in both groups were all diaphyseal with displacement of the whole diameter. The degree of comminution was graded : Grade I â€" minor, with one or two small fragments ; Grade II â€" moderate, with three or four small fragments or a large displaced butterfly fragment ; or Grade III â€" with severe comminution.In the majority of patients the AO nailing was performed using a closed technique but in seven ofthe 23 fractures in the head injury group the fracture was openly reduced before fixation ; in Group II only two patients required open reduction. The time lapse from injury to nailing was recorded.An attempt was made to establish the rigidity of fixation in terms of the size of the nail used and the diameter of the medullary cavity at the level of the fracture. In all cases the medullary cavity was reamed to take a large nail at the narrowest part of the medullary cavity but excessive reaming was not performed; therefore, in fractures below the mid-shaft of the femur, the fixation was deemed not to be rigid owing to the poor fit of the nail within the med...

Significant changes in the type of collagen, the fibril diameter and the nature of the crosslinks have been demonstrated in the joint capsules of subjects with congenital displacement of the hip (CDH). These changes are probably tissue specific since no detectable change could be observed in the skin of these subjects compared to controls. These preliminary biochemical studies clearly demonstrate that CDH involves an error in collagen metabolism.

The hips of twenty full-term African neonates have been examined in detail to determine any anatomical factors which might explain the difference in the incidence of congenital dislocation of the hip in the African and in the Caucasian. Measurements included the degree ofanteversion ofthe femoral neck and the acetabulum and the diameter and depth of the acetabulum. The acetabulum tended to be deeper and to vary within a much narrower range than that reported for Caucasians, lending indirect support to the theoretical role of acetabular dysplasia in the aetiology of congenital dislocation of the hip. Measurements of the anteversion of the acetabulum and femoral neck were similar to those given for Caucasians.