In a prospective study, 60 patients with acute acromioclavicular dislocation were randomly allocated to treatment with a broad arm sling or to reduction and fixation with a coracoclavicular screw. Of these 54 were followed for four years. Conservatively-treated patients regained movement significantly more quickly and fully, returned to work and sport earlier and had fewer unsatisfactory results than those having early operation. For severe dislocations, with acromioclavicular displacement of 2 cm or more, early surgery produced better results. Conservative management is best for most acute dislocations, but younger patients with severe displacement may benefit from early reduction and stabilisation.

A 10 day study of nitrogen and calorie balance has been undertaken in 61 women patients aged 65-96 years (mean age 81 years) with femoral neck fractures. All underwent fracture surgery with an inhalation anaesthetic lasting from 45 min to 2 h. Intake of ward food varied widely but was always low with a mean of 127 mg N kg-1 and 17 kcal kg-1 daily. Daily nitrogen production was 85-250 mg N kg-1 (mean 158 mg N kg-1) and calorie expenditure was 17-48 kcal kg-1 (mean 32 kcal kg-1). These were greatest in trochanteric fracture patients. Of the 61 patients, 90 per cent were in negative nitrogen balance with a mean 8 day deficit of 411 mg N kg-1 and all in negative calorie balance, mean 141 kcal kg-1. The deficits were greatest in trochanteric fracture patients. Sip feeding with supplementary enriched drinks raised protein and calorie intake substantially. Both nitrogen and calorie balance were significantly improved, but large calorie deficits remained; intolerance of the supplements proved to be a handicap in correcting the deficits in many patients.

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A consecutive group of ninety-three patients with ninety-six affected joints, have been reviewed retrospectively to provide information regarding the incidence and longer term effects of injuries to the proximal interphalangeal joint of the fingers. The patients have been grouped according to the severity of the injury, judged clinically and radiologically. From this review it would appear that these injuries are somewhat less common than is suggested in the literature. The severity of the trauma would seem to influence the result in that some thirty per cent with dislocation or fracture-dislocation did badly and of these forty-three per cent had open injuries. Some experimental work on fresh cadavers, to investigate the damage to the ligaments in the more common dorsal dislocation, has been included. From our findings, suggestions have been made regarding the treatment of these injuries.