Abstracts atlas was demonstrated, as well as syringomyelia and hydrocephalus. The weakness became less after fusion of head to neck and atlas to axis. Collalto P. M., De Muth W. W., Schwentker E. P. and Boa1 D. K. (1986) Traumatic atlanto-occipital dislocation. J. Bone Joint Surg. 68A, 1106. Closed dislocation
A fall resulted in forward dislocation of the proximal pole of the scaphoid bone of the wrist. Operation showed that the bone retained a small band of soft tissue. It was easily replaced and was fixed with two Kirschner’s wires passed through the styloid process of the radius and on into the capitate bone for 6 weeks. Two years later the wrist was useful, with no scintigraphic evidence that the bone was dead. Engkvist 0. and Ekenstam F. A. F. (1986) Closed dislocation of the scaphoid. Stand. J. Plast. Reconstr. Surg. 20, 239.
RECREATIONAL INJURIES Overuse syndrome
The account by a sensitive and artistic person of what may to the listener seem to be vague and unconvincing symptoms deserves patience and the advice of an experienced teacher of the instrument concerned rather than scepticism and reassurance. Fry M. J. H. (1986) Overuse syndrome in musicians: prevention and management. Lancet ii, 728.
ORGANIZATION TOPICS AND ACCIDENT PREVENTION Aftermath
of nuclear attack
Having accepted that casualties would be overwhelming, the author gives careful thought to the policies on which sorting of casualties might be based. Understandably. this poses more problems than it solves. Pledger H. G. (1986) Image of casualties after nuclear attack. Lancet ii, 678. In-hospital
Although it deals with hearts that stop beating in hospital this article has important lessons for all who are responsible for teaching nurses, doctors and others how to react to these emergencies. Sillivan M. J. J. and Guyatt G. H. (1986) Simulated cardiac arrests for monitoring quality of in-hospital resuscitation. Lancer ii, 618. Admission
guidelines for head injuries
Policies for admission after head injury varied a good deal from that since recommended by a group of neurosurgeons. From 22 to 71 per cent of patients undergoing radiography of the skull and having signs and symptoms that warranted admission to hospital were in fact admitted, and from 1 to 20 per cent without such characteristics were admitted. Implementing the group of neurosurgeons’ recommendations could reduce admissions by up to 46 per cent. Fowkes F. G. R., Ennis W. P., Evans R. C., Roberts C. J. and Williams L. A. (1986) Admission guidelines for head injuries: variance with clinical practice in accident and emergency units in the U.K. Br. J. Surg. 73. 891.
VASCULAR INJURIES Inferior vena cava injury
The policy of exploring retroperitoneal haematomas that might signify tearing of the inferior vena cava is questioned on the grounds that torrential bleeding may result, that complications are rare, that experimental lesions in pigs healed well and that infusions by way of the tributaries of this great vein did not run to waste through the tear. Selective exploration is favoured. Posner M. C., Moore E. E., Greenholz S. K., Durdick D. C. and Clark D. C. (1986) Natural history of untreated inferior vena cava injury and assessment of venous abscess. J. Trauma 26, 698.
In 10 cases localized injuries of the limbs, neck and trunk were followed at intervals ranging from 2 days to 6 years by motor symptoms in the injured part, and 3 patients developed Parkinson’s disease. More often than not there was no persistent pain. The author suggests that the sequence of events had an organic basis. Schott G. D. (1986) Induction of involuntary movements by peripheral trauma: an analogy with causalgia. Lancet ii, 712. Lead poisoning from gunshot wound
Five out of seven limbs survived reattachment after being without a blood supply for 10-14 hours. All five regained useful control of the elbow and two regained useful function of the wrist and hand; they required an average of 2.8 secondary operations, one of which was amputation through the forearm. Wood M. B. and Cooney W. P. (1986) Above limb replantation. Functional results. J. Hand Surg. IlA, 682.
A man developed signs of poisoning by lead 16 months after a 0.32-calibre bullet lodged in his wrist. Viegas S. F. and Calhoun J. H. (1986) Lead poisoning from a gunshot wound to the hand. J. Hand Surg. 1lA. 729. Frostbite and guanethidine
A patient with symmetrical frostbite of his feet derived no benefit from guanethidine blocks on one side only. Engkvist 0. (1986) The effect of regional intravenous guanethidine block in acute frostbite. Stand. J. Plast. Reconstr. Surg. 20, 243.