We report a prospective study of the incidence of fractures in the adult population of Edinburgh, related to age and gender. Over a two-year period, 15,293 adults, 7428 males and 7865 females, sustained a fracture, and 5208 (34.0%) required admission. Between 15 and 49 years of age, males were 2.9 times more likely to sustain a fracture than females (95% CI 2.7 to 3.1). Over the age of 60 years, females were 2.3 times more likely to sustain a fracture than males (95% CI 2.1 to 2.4). There were three main peaks of fracture distribution: the first was in young adult males, the second was in elderly patients of both genders, mainly in metaphyseal bone such as the proximal femur, although diaphyseal fractures also showed an increase in incidence. The third increase in the incidence of fractures, especially of the wrist, was seen to start at 40 years of age in women. Our study has also shown that 'osteoporotic' fractures became evident in women earlier than expected, and that they were not entirely a postmenopausal phenomenon.

In a prospective, randomised controlled trial, 68 children who had a completely displaced metaphyseal fracture of the distal radius were treated either by manipulation (MUA) and application of an above-elbow cast alone or by the additional insertion of a percutaneous Kirschner (K-) wire. Full radiological follow-up to union was obtained in 65 children and 56 returned for clinical evaluation three months after injury. Maintenance of reduction was significantly better in the K-wire group and fewer follow-up radiographs were required. There was no significant difference in the clinical outcome measured three months after injury. Seven of 33 patients in the MUA group had to undergo a second procedure because of an unacceptable position compared with none of the 35 in the K-wire group (chi-squared test, p < 0.01). One patient in the K-wire group required exploration for recovery of a migrated wire. We conclude that the use of a percutaneous K-wire to augment the reduction of the fracture in children who have a completely displaced metaphyseal fracture of the distal radius is a safe and reliable way of maintaining alignment of the fracture.

No abstract

SUMMARY Simultaneous ambulatory records of gastric antral and body pH were made over 24 hours in nine healthy volunteers by means of endoscopically positioned and anchored glass electrodes. Intragastric pH was temporarily raised after the endoscopy with the median pH value 30 minutes after the procedure being 3.9 (range 1 5-70) for the antrum and 4.1 (range 1 5-70) for the body. Daytime pH (median pH value between 1200 h and 2300 h) was lower in the antrum (median=1.9, range 16-2.6) than in the body (median=2.7, range 1.8-45) (p<0O05) and this was because of the rise in pH on eating being less marked in the antrum than in the body. The median peak pH recorded during the evening meal was only 4.1 (range 24-642) in the antrum compared with 6.3 (range 4.4-6.7) in the body (p<001). Preprandial pH (median value over the hour prior to the evening meal) was similar in the antrum (median= 1 9, range 1 2-25) and body (median= 1 9, range 1.3-28). Night-time pH (median pH value between 2300 h and 0500 h) in six subjects remained low and was similar in the antrum (median= 14, range 12-1.7) and body (median=13, range 11-1-7). In two subjects, however, there were episodes of raised night-time pH which were more marked in the antrum than in the body. Antral biopsies showed gastritis in four of the nine normal volunteers, which in three was associated with the presence of campylobacter-like organisms. This study shows the significant regional variations in day and night-time intragastric pH.Over the past decade there has been a dramatic increase in the use of ambulatory pH monitoring of the upper gastrointestinal tract (GIT) for research purposes and as an aid to diagnosis. Previously, most studies of intragastric pH depended on the analysis of aspirated gastric juice and had several shortcomings. Gastric aspiration may invoke duodenogastric reflux or stimulate acid secretion' and may be difficult after a solid meal or during the night when little juice is present in the stomach.3 The use of in situ pH electrodes overcomes these problems and also allows the monitoring of pH in specific regions of the stomach rather than just giving a mean intragastric value. Because of the problems of maintaining the position of electrodes within the stomach, little is