The serum copper levels of 46 elderly patients with fractures of the femoral neck were assayed and found to be significantly lower than those of a group of controls matched for age and sex. These findings are consistent with nutritional copper deficiency which may contribute to the development of fractures by reducing bone strength.

The changes in serum adjusted ionised calcium and parathyroid hormone (F H) were prospectively studied in 32 patients with isolated tibial fractures, freated conservatively. We measured serum albumin, adjusted total calcium, phosphate, pH, adjusted ionised calcium and PTH at intervals until the fractures had healed. The mean ionised calcium adjusted for pH fell within 24 hours of injury, and then rose to a peak at between four and six weeks. These changes cannot be explained by changes in serum pH or PTH. The restoration of normal ionised calcium levels after fracture coincided with the period when the callus was being calcified. Analysis of the changes in ionised calcium, phosphate and PTH suggests that PTH levels alter in response to changes in ionised calcium levels. PTH is highest immediately after fracture and lowest, often not recordable, at six weeks. The cause of the changes in the ionised calcium level has yet to be elucidated.

Case report. A 14-year-old schoolboy was bitten by an Alsatian dog, sustaining a puncture wound over the dorsal surface ofthe terminal interphalangealjoint of the right little finger. Primary closure of the wound was

Revision rates in forefoot surgery. Foot Ank/e 1982; 3:47-9. Hatcher RM, Smith SD. A procedure for correction of the severely subluxed second hammer toe.

No abstract