We recorded all the distal forearm fractures in inhabitants under 20 years of age in Frederiksborg County, Denmark, throughout 1985. The population at risk was 97,791 persons, and fractures occurred in 269 boys and 205 girls. The peak incidence in girls occurred at ages 10-12 (105 per 10,000) and in boys at ages 12-14 (100 per 10,000). Fractures occurred more often in the autumn than in the spring.

Background A single injection of bupivacaine after wound closure reduces the need for analgesics and increases flexion after total knee replacement (TKR). We have therefore studied the effect of continuous injection of morphine and ropivacaine after TKR on range of movement and length of hospital stay.Patients and methods In an open intervention study, we assigned 154 consecutive patients who had primary unilateral TKR for osteoarthrosis. The intervention was continuous intraarticular injection of morphine 20 mg/ mL, 0.5 mL plus ropivacaine 2 mg/mL, 100 mL; bolus 20 mL and 2 mL/hour from 24 to 72 hours postoperatively. Group 1 (10 women and 8 men) received standard postoperative analgesics and group 2 (11 women and 7 men) also received continuous intraarticular morphine and ropivacaine as described above. Group 3 (14 women and 4 men) received double this dose (4 mL/hour) from 24 to 72 hours postoperatively. To assess the safety of the intraarticular treatment, an additional group of 100 consecutive patients was followed (group 4).Results At discharge, flexion was 70° (60-100) in group 1, 100° (70-115) in group 2 and 110° (90-130) in group 3. Hospital stay was reduced from 9 (7-11)days in group 1, to 7 (5-10) days in groups 2 and 3. Number of days elapsed until the patient was walking with crutches was reduced from 5 (3-8) to 4 (3-6) and 3 (3-9), respectively. In the intervention groups, the need for analgesics was reduced during the hospital stay. Deep infection was registered in 1 patient.Interpretation Continuous intraarticular morphine and ropivacaine reduce pain and enhance rehabilitation after total knee replacement. Before advocating this as

Total rupture of the femoral biceps muscle is a rare diagnosis, probably because it is disregarded. Few cases have been reported in the literature, and in all cases surgery has been performed. The 2 patients described both had a complete rupture of the femoral biceps tendon a few centimetres proximally to its insertion at caput fibulae. Both sustained the injury during a soccer game. One patient was treated conservatively and the other operated. The final results were similar, but the conservatively treated patient was fully restored after 2 to 3 weeks, whereas the operated patient took more than 3 months to obtain full function.

We investigated the effects of polymerization heat and toxicity of polymethylmetacrylate bone cement in the canine tibial diaphysis. Heat was studied by filling the tibias with either bone cement or bone wax contained in a monomer tight membrane pouch. Toxicity was studied by filling both tibias with cement, with the control side contained in the membrane pouch. Bone blood perfusion was measured by microsphere technic, and bone remodeling by 99mTc-methylene diphosphonate uptake and by histologic technique. In bone exposed to the combination of polymerization heat and monomer, both perfusion and remodeling were impaired. We did not find any effects of polymerization heat alone. We conclude that hot toxic chemicals from bone cement during polymerization may inhibit bone blood perfusion and remodeling, whereas heat alone seems to be of minor importance for the regenerative processes in cemented diaphyseal bone.