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.

In a series of 48 painfully restricted wrists denervation was used during a 6-year period on wide indications as a surgical alternative. The observation time averaged 2.4 years. Pain relief occurred in 56% of the patients. Considering the simplicity of the method and the lack of serious complications, it is concluded that denervation of the wrist is worth trying as a palliative measure prior to more extensive surgery.

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SummaryDextran fractions of different molecular weights were given to dogs in order to ascertain at which molecular weight dextran interferes with the coagulation factors.1. Infusions of dextran with an average molecular weight of 130,000 (Intradex®) and in doses of 1.5 g dextran per kg body weight induced a moderate coagulation defect. There was a slight prolongation of the bleeding time and a slight drop in platelet count. Values for AHF, factor V, prothrombin and factor VII, and fibrinogen declined by 10 to 40% of the original values.2. Infusions of dextran with an average molecular weight of 75,000 (Macrodex®) in doses of 1.5 g per kg body weight did not produce any significant changes in bleeding time and platelet count. The AHF level decreased by 40% and the levels of prothrombin and factor VII, factor V and fibrinogen by about 10% of the original values. In a dose of 2 g per kg body weight this fraction produced a significant coagulation defect with a fall of the various coagulation factors by about 40 to 50%.3. A dextran fraction with an average molecular weight of 60,000 in doses of 1.5 g per kg body weight did not prolong the bleeding time and caused only a very slight decrease in platelet count. There were no changes in the values for AHF, factor V, prothrombin and factor VII but a slight drop occurred in the fibrinogen levels.4. Dextran with an average molecualr weight of 40,000 (Rheomacrodex ® ) in doses of 1.5 g per kg body weight did not affect the bleeding time or the platelet count. Nor did any significant decline occur in the amounts of the other coagulation factors.No changes in the Duke or in the Ivy bleeding times were observed in human beings given Macrodex® and Rheomacrodex® in doses of 1 g per kg body weight.Intradex® and Macrodex® in doses of up to 1-1.5 g per kg bodyweight to persons with normal blood coagulation are considered not associated with any appreciable risk of haemorrhage, but they are contraindicated in patients with haemorrhagic diathesis. The experiments indicate that Rheomacrodex® in similar doses does not incur any risk of haemorrhage.

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