When Colles first described his familiar fracture in 1814, he claimed that the injured limb would eventually regain â€oeperfect freedom in all its motions―. Though some would agree with such an observation (Smaill 1965), many would not (Grasby and Trick 1929;Mayer 1940; Bacorn and Kurtzke 1953; Golden 1963;Cole and Obletz 1966). Frequent attempts have therefore been made to identify, as early as possible, the factors which may lead to a poor result.A number of radiographic features have been regarded as important for prognosis, notably intra articular involvement (Eelma and McElfresh 1983), volar tilt (Rubinovich and Rennie 1983), dorsal tilt,
Pilonidal disease of the natal cleft is a common condition responsible for much morbidity, and its treatment places a burden on hospital and community resources. Many methods of treating chronic pilonidal sinuses have been described and the optimum treatment remains a topic for debate. Phenol injection of pilonidal sinuses has been the routine practice of two consultant surgeons in Ipswich for over 15 years, while the remaining consultant surgeons excise and pack sinuses. The relative merits of these procedures, as used in 169 patients over a 15-year period, have been reviewed. Patients and methodsThe hospital records of patients presenting with acute or chronic pilonidal disease, between 1970 and 1985, were reviewed. Age, sex, presentation, number of sinus openings, treatment, complications, inpatient stay, and outcome were recorded.During the period studied 226 patients were treated for natal cleft pilonidal disease. Seventy-four patients (49 male patients and 25 female patients) presented as emergencies with pilonidal abscess and 152 (1 14 male patients and 38 female patients) were referred with a chronic pilonidal sinus. Mean age at presentation was 26.6 years (range 14-62 years). Twenty-eight patients presenting with an abscess subsequently developed a chronic sinus, resulting in 180 patients seen for pilonidal sinus. Eleven received no treatment, 65 were treated by excision and packing and 104 received phenol injections.Excision of sinuses was performed en bloc and the wounds were packed and allowed to heal by secondary intention. The technique of phenol injection was similar to that described by Maurice and Greenwood'. Under general anaesthesia, with an endotracheal tube, the patient was positioned prone and the buttocks liberally covered with paraffin jelly. Eighty per cent phenol was injected into the sinus, left for lmin, and the sinus then curretted; this was repeated three times. Patients with asymptomatic, shallow sinuses were edvised that treatment was unnecessary.Following excision of sinuses, patients received daily dressings until discomfort subsided sufficiently to allow a district nurse to continue the dressings at home. Thereafter patients were reviewed at 2-3 week intervals until their wound healed. Patients treated by phenol injection were kept in hospital overnight, and allowed home the following day with instructions to bathe daily and keep the area shaved. Regular dressings and analgesia were not required by patients treated with phenol. Outpatients review was continued at 2-3-week intervals until the sinus healed. Fifty-two (80 per cent) patients treated by excision and 79 (76percent) of those treated with phenol were seen 3-6 months after healing to exclude or identify recurrence.
Osteonecrosis of the femoral head is a severely disabling complication of steroid immunosuppression in renal transplant patients. We report 31 total hip arthroplasties in 21 renal transplant recipients with an average follow-up of six years. There were no problems with wound healing or infection despite full immunosuppression. Four hips developed symptomatic loosening but the other results were excellent, comparing well with other methods of treatment for osteonecrosis. Ten patients died during the follow-up period. Total hip replacement is a safe and effective treatment for transplant recipients and, in view of their limited life expectancy, should be considered at an early stage in their treatment. Osteonecrosis associated with steroid therapy was first described by Pietrogrande and Mastomarino in 1957, and later reported in patients after renal transplants (Starzl et al. 1964). The femoral head is the most common site to be involved, often bilaterally and, since transplantation for end-stage renal disease became established, it is recognised as a cause of significant morbidity after otherw ise successful transplant surgery.
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