Fracture of the scaphoid is the most common injury of the carpus. Inadequate treatment frequently leads to non-union, which causes pain and serious disability. In the present study 134 scaphoid fractures treated during the period 1961-70 are reviewed. In fresh fractures less than 4 weeks old, bony union occurred in 95% with proper conservative treatment. The vexed question of whether a high or low circular cast should be used may not really be so important. In the present study, both methods of external splintage have given favourable results. It is indisputable, however, that other factors, such as the age of the fracture, its type and location are of great importance for the final result. It was also found that fracture dislocation greater than 1 mm regularly led to pseudarthrosis. Operative treatment is suggested in these cases, and the Matti-Russe technique has proved to be an excellent method for treatment of pseudarthrosis of the scaphoid. The study further confirmed that fractures of the scaphoid in children are more common than is usually supposed. They were all located in the distal two-thirds of the bone and it is suggested that this pattern of distribution is typical of childhood.

The formation of stones in patients with cystinuria can be counteracted by reducing the urinary concentration of cystine and by increasing its solubility. Thirty-one patients with homozygous cystinuria and treated with tiopronin (2-mercaptopropionylglycine) were followed for between 0.4 and 12 years (median 8.8). With the aim of avoiding cystine concentrations above 1200 mumol/l, the daily dose varied between 500 and 3000 mg (median 1500). The therapeutic effect was evaluated from the clinical symptoms and repeated radiographic examinations. The rate of stone formation during the treatment period was reduced by 60% in comparison with the pretreatment period (P < 0.001). The frequency of active stone removal was reduced by 72% (P < 0.05). The formation of new stones was associated with a higher cystine concentration than was the case during periods when stone formation and stone growth were excluded (P < 0.05). The probability of new stone formation increased with increasing concentrations of cystine up to 1100 mumol/l, but stone formation was not accentuated above 1200 mumol/l. There was no significant relationship between the 24 h excretion of cystine and stone formation. It is concluded that the formation of cystine stones can be efficiently counteracted during treatment with tiopronin, guided by analysis of the concentration of urinary cystine.

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Bendroflumethiazide was administered to 85 patients (62 men, 23 women) with recurrent calcium oxalate stone disease. Side effects leading to interrupted treatment were observed in 26 (31%) of the patients. Fifty-nine (40 men, 19 women) remained on treatment for a mean (+/- SD) period of 3.7 +/- 1.0 years, and 21 reported late side effects. Twenty patients were given 2.5 mg bendroflumethiazide daily (Group A), 27 were given 2.5 mg twice daily (Group B), and 12 were given 5 mg once daily (Group C). Eight patients (14%) formed new stones and another two demonstrated stone growth during treatment. A beneficial effect on stone formation was observed in Groups B and C but not in Group A. Patients who failed to respond to treatment had a pre-treatment stone formation rate of 0.74 stones per year compared with 0.22 in those who did not form new stones. Those with recurrence during treatment had a lower citrate excretion than other patients. No effect on urinary citrate was recorded during treatment, and long-term treatment with bendroflumethiazide did not affect oxalate excretion.

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