the British Journal of Accident Surgery (1992)Vol. 23/No.1 Injury:
60
and had no clinical evidence of a reduced power-grip. Traumatic ruptures of other extensor tendons have been widely reported in the literature and are usually associated
with Colles’ fracture or rheumatoid arthritis (Milch and Epstein, 1987). One report of delayed surgical repair of ECRL at 12 days reported residual weakness of wrist extension and grip power. There are no other reports in the literature of excision of the ECRL (Sadr and Lalehzarian,
Last
R. J. (1984)Anatomy, Regional and Applred, 7th Ed. London and Edinburgh: Churchill Livingstone. Traumatic rupture of extensor Milch E. and Epstein M. D. (1987) pollicis longus tendon. Ann. Pht. Sqg. 19, 460. Sadr B.and Lalehzarian M. (1987) Traumatic avulsion of tendon of extensor carpi radialis longus. 1. Hana’ Surg. 12A, 1035.
1987). Paper accepted
17 May
1991
References Brand P. W., Beach R. B. and Thompson D. E. (1981) Relative tension and potential excursion of muscles in forearm and hands. 1. Hand Surg. 6,209.
Requests fur reprints should be addresd
General Surgery, Queen mouth PO6 3LY. UK.
Alexandra
fa
Dr. 1.1. So&gate,
Hospital,
Cosham,
SHO Ports-
Traumatic hip dislocation with ipsilateral femoral shaft fracture in a child: an ‘open and closed’ case R. N. S. Slater and P. R. Allen Orthopaedic
and Trauma Surgery Unit, Lewisham Hospital, London, UK
Case report A I.&year-aid boy was struck on the feft thigh by a car travelling at about 30mph. On examination in hospital, the left leg lay adducted and internally rotated. The thigh was swollen. A radiograph confirmed femoral shaft fracture with posterior dislocation of the hip (Figure I). With minimal delay the patient was anaesthetized. but attempted closed reduction of the dislocation failed because of inadequate purchase on the proximal fragment. Open reduction and internal fixation of the fracture was performed using an a-hole dynamic compression plate. The dislocation then reduced easily in the usual way (Figure 2). Movements of the patient were limited for the first 3 weeks postoperatively by skin traction to allow tears in the hip capsule to heal. At 6 months after the injury, union of the fracture was confirmed by radiography, and bone scintigraphy revealed normal vascularity of the femoral head.
Discussion Traumatic hip dislocation with ipsilateral femoral shaft fracture is very rare, and rarer still in a child (Malkawi, 1982); many trauma surgeons will not see a case in their working lifetime. The dislocation may be missed (Helal and Skevis, 1967). We stress the importance of awareness of this combination of injuries and of obtaining adequate radiographs of joints proximal and distal to long bone fractures. .$“ 1992 Butterworth-Heinemann
0020-13&33/92/01006&02
Ltd
Figure I. Radiograph on admission showing ture and posterior dislocation of the hip.
femoral shaft I&C-
Case reports
61
The need for urgent reduction of a traumatically dislocated hip is not in doubt (Epstein, 1973) but how this is best achieved with an ipsilateral fracture of the femoral shaft is a point for debate; reported management options are anecdotal. We felt any hip surgery could only compromise further viability of the femoral head and any local haematoma would decompress through capsular tears; hence we sought closed reduction. We achieved this by restoring the lever-arm properties of the femur by plate osteosynthesis; intramedullary nailing could not be considered because of skeletal immaturity.
References Epstein H. C. (1973)Traumatic dislocations of the hip. Clin. Orflwp. 92, 116. Helai R. and Skevis X. (1967) Unrecognised dislocation of the hip in fractures of the femoral shaft. J. Bone joint Surf. 49B, 293, Malkawi H. (1982) Traumatic anterior dislocation of the hip with fracture of the shaft of the ipsilateral femur in children: case report and review of the literature. 1. Pediah. 01&p. t(3), 307.
Paper accepted
Figure 2. Postoperative radiograph showing plate osteosynthesis of the fracture and reduction of the dislocation.
18 March 1991.
Ketpests for reprirrtsshould be addressed io: Mr R. N. S. Slater, Senior Orthopaedic Registrar, William Harvey Hospital, Ashford, Kent TN24 OLZ, UK.
Attempted suicide by hanging N. Nayeem Accident and Emergency
Department,
Milton Keynes General Hospital, Milton Keynes, UK
Introduction Hanging is a common means of suicide, with a male to female ratio of 3: I. We would like to report the management and outcome of the case of a young man who attempted to hang himself. Recent mortahty statistics (Klerman and Weissman, 1989: Lowy et al., 1990) show an increasing suicide rate among young men aged 15-34 years. This is likely to be paralleled by an increasing rate of near miss suicides presenting to accident and emergency departments. .(. I 992 Butterworth-Heinemann 002C-1383/92/010061-02
Ltd
Case report A 27.year-old
man was found hanging by a rope from the bannister. He had left his girlfriend IS min earlier to go and have a bath. The patient had a short history of depression because of his inability to sell his house, but had not shown any suicidal intentions. The patient was immediately released by his girlfriend and brought to the accident and emergency department by ambulance within 20min of the incident, where on arrival he was making
60
and had no clinical evidence of a reduced power-grip. Traumatic ruptures of other extensor tendons have been widely reported in the literature and are usually associated
with Colles’ fracture or rheumatoid arthritis (Milch and Epstein, 1987). One report of delayed surgical repair of ECRL at 12 days reported residual weakness of wrist extension and grip power. There are no other reports in the literature of excision of the ECRL (Sadr and Lalehzarian,
Last
R. J. (1984)Anatomy, Regional and Applred, 7th Ed. London and Edinburgh: Churchill Livingstone. Traumatic rupture of extensor Milch E. and Epstein M. D. (1987) pollicis longus tendon. Ann. Pht. Sqg. 19, 460. Sadr B.and Lalehzarian M. (1987) Traumatic avulsion of tendon of extensor carpi radialis longus. 1. Hana’ Surg. 12A, 1035.
1987). Paper accepted
17 May
1991
References Brand P. W., Beach R. B. and Thompson D. E. (1981) Relative tension and potential excursion of muscles in forearm and hands. 1. Hand Surg. 6,209.
Requests fur reprints should be addresd
General Surgery, Queen mouth PO6 3LY. UK.
Alexandra
fa
Dr. 1.1. So&gate,
Hospital,
Cosham,
SHO Ports-
Traumatic hip dislocation with ipsilateral femoral shaft fracture in a child: an ‘open and closed’ case R. N. S. Slater and P. R. Allen Orthopaedic
and Trauma Surgery Unit, Lewisham Hospital, London, UK
Case report A I.&year-aid boy was struck on the feft thigh by a car travelling at about 30mph. On examination in hospital, the left leg lay adducted and internally rotated. The thigh was swollen. A radiograph confirmed femoral shaft fracture with posterior dislocation of the hip (Figure I). With minimal delay the patient was anaesthetized. but attempted closed reduction of the dislocation failed because of inadequate purchase on the proximal fragment. Open reduction and internal fixation of the fracture was performed using an a-hole dynamic compression plate. The dislocation then reduced easily in the usual way (Figure 2). Movements of the patient were limited for the first 3 weeks postoperatively by skin traction to allow tears in the hip capsule to heal. At 6 months after the injury, union of the fracture was confirmed by radiography, and bone scintigraphy revealed normal vascularity of the femoral head.
Discussion Traumatic hip dislocation with ipsilateral femoral shaft fracture is very rare, and rarer still in a child (Malkawi, 1982); many trauma surgeons will not see a case in their working lifetime. The dislocation may be missed (Helal and Skevis, 1967). We stress the importance of awareness of this combination of injuries and of obtaining adequate radiographs of joints proximal and distal to long bone fractures. .$“ 1992 Butterworth-Heinemann
0020-13&33/92/01006&02
Ltd
Figure I. Radiograph on admission showing ture and posterior dislocation of the hip.
femoral shaft I&C-
Case reports
61
The need for urgent reduction of a traumatically dislocated hip is not in doubt (Epstein, 1973) but how this is best achieved with an ipsilateral fracture of the femoral shaft is a point for debate; reported management options are anecdotal. We felt any hip surgery could only compromise further viability of the femoral head and any local haematoma would decompress through capsular tears; hence we sought closed reduction. We achieved this by restoring the lever-arm properties of the femur by plate osteosynthesis; intramedullary nailing could not be considered because of skeletal immaturity.
References Epstein H. C. (1973)Traumatic dislocations of the hip. Clin. Orflwp. 92, 116. Helai R. and Skevis X. (1967) Unrecognised dislocation of the hip in fractures of the femoral shaft. J. Bone joint Surf. 49B, 293, Malkawi H. (1982) Traumatic anterior dislocation of the hip with fracture of the shaft of the ipsilateral femur in children: case report and review of the literature. 1. Pediah. 01&p. t(3), 307.
Paper accepted
Figure 2. Postoperative radiograph showing plate osteosynthesis of the fracture and reduction of the dislocation.
18 March 1991.
Ketpests for reprirrtsshould be addressed io: Mr R. N. S. Slater, Senior Orthopaedic Registrar, William Harvey Hospital, Ashford, Kent TN24 OLZ, UK.
Attempted suicide by hanging N. Nayeem Accident and Emergency
Department,
Milton Keynes General Hospital, Milton Keynes, UK
Introduction Hanging is a common means of suicide, with a male to female ratio of 3: I. We would like to report the management and outcome of the case of a young man who attempted to hang himself. Recent mortahty statistics (Klerman and Weissman, 1989: Lowy et al., 1990) show an increasing suicide rate among young men aged 15-34 years. This is likely to be paralleled by an increasing rate of near miss suicides presenting to accident and emergency departments. .(. I 992 Butterworth-Heinemann 002C-1383/92/010061-02
Ltd
Case report A 27.year-old
man was found hanging by a rope from the bannister. He had left his girlfriend IS min earlier to go and have a bath. The patient had a short history of depression because of his inability to sell his house, but had not shown any suicidal intentions. The patient was immediately released by his girlfriend and brought to the accident and emergency department by ambulance within 20min of the incident, where on arrival he was making
