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.

As a part of a preoperative investigation, spirometry and blood gas tensions were studied in 64 subjects with X-ray-verified hiatus hernia (34 reflux sliding, 22 mixed, and 8 of paraesophageal variety). According to the transverse diameter of the hernia, they were divided into 3 groups, small (2–5.9 cm), medium (6–9.9 cm), and large (10–17 cm) hernias. No correlation between the size of the hernia, reflux incidence, and spirometric findings could be demonstrated. A significant reduction of the arterial oxygen tension was found in small hernias and in vital capacity and maximal voluntary ventilation (MVV) in medium-sized hernias. Significant reduction in MVV was noted in the large hernia group. A common spirometric finding in all groups was a significant increase in residual volume and wash-out volume. The incidence of restrictive or obstructive pulmonary impairment was high in large (39%) and small (32%) hernias and relatively low in medium-sized hernias (8%). Roentgenological fibrosis was not found in any of the patients, while 4 showed emphysematous changes.

A roentgenographic study was carried out on 104 Silastic Finger Joint Implants, Swanson design. Sixty-two of the implants were examined in the anterio-posterior-projection (AP) from 4 months to 5 1/2 years postoperatively, a total of 116 examinations. Forty-two implants were examined in the AP-projection and in the lateral projection by tomography in maximum active extension and flexion from 9 days to 42 months postoperatively, a total of 110 examinations. Stem fractures were found in 11/104 implants: two of these preceded by a laceration of the implant surface visualized by tomography. Fragmentation of the midsection was found in 14/104 implants. Cortical erosion was seen radially in the phalanx and the metacarpal bone in some joints showing ulnar deviation, predominantly MCP joints II and III. On the tomograms a cortical erosion dorsally in the metacarpal bone could be demonstrated. Particularly around the distal stem was found an intramedullary bone lamella, varying in distance from the stem as well as in density and regularity. Bone resorption was found at the site where the midsection bore on the metacarpal bone and the proximal phalanx, resulting in a migration of the implant in a proximal and/or distal direction. The migration of the implant was evaluated on the tomograms with maximum active extension and classified into 4 Grades. Concomitant with the migration in the proximal direction a bony spur developed volarly at the resected end of the metacarpal bone, also seen in the AP-projection. The degree of maximum joint flexion was measured on the tomograms by drawing a line along the dorsal contour of each bone. In some cases flexion was found to decrease as a consequence of implant migration in the distal direction or the development of a bony spur. In several cases the range of flexion was maintained by gliding of the stems, particularly the distal one.

In the present study radiological evaluation of 45 cases of Bennett's fracture reveals that different types of fracture dislocations correlate with late and typical deformities of the metacarpal joint surface. Functional results with special reference to treatment by closed reduction and percutaneous pinning show that this method was successful in most cases treated (92%). It is concluded that percutaneous pinning offers a simple and reliable way of fixation which eliminates the need for X-rays during the healing period. Untoward effects on the joints caused by the pins were not observed and the incidence of secondary arthrosis was not higher than reported for other methods of internal fixation. 4 11 30 Scand J Plast Reconsfr Surg 5 Scand J Plast Surg Recontr Surg Hand Surg Downloaded from informahealthcare.com by University of Toronto on 11/19/14 For personal use only. 26, 3. ThorCn, L. 1956. A new method of extension treatment in Bennett's fracture. Acta Chir Scand 110, 485. Scand J Plast Reconstr Surg 5 Scand J Plast Surg Recontr Surg Hand Surg Downloaded from informahealthcare.com by University of Toronto on 11/19/14For personal use only.

Two kindreds showing an accumulation of secundum-type atrial septal defects have been traced back to common ancestors in the 18th century. The distribution of affected individuals in the combined pedigree satisfies the criteria of a dominant mode of inheritance. The diagnosis is considered certain in 16 cases (verified at operation i n nine, at autopsy in one, and by heart catheterization in two) and more or less strongly suggested in four. Evidcnce from this and some additional reports gives support to the hypothesis that in exceptional cases atrial seplal defect may be inherited as an autosomal dominant character showing high or even complete penetrance and little variation in expressivity. This does not contradict the generally accepted view that, in most cases, atrial septal defect as well as other cardiovancular malformations must he duc to multifactorial mechanisms.