Aim: To evaluate the effect of traction on the compartment pressures during intramedullary nailing of closed tibial shaft fractures.

Materials and Methods: The study design was a randomised prospective trial. The period of the study was September 1999 to December 2000. 30 consecutive patients with Tscherne C1 fractures were randomised into two groups. 16 patients underwent intramedullary nailing of the tibia with traction and 14 patients with traction. Compartment pressures were measured before the application of traction or commencement of the procedure and at the end of the procedure. The method described by Guilli and Templeman was used to measure all the four compartments of the injured limb. The pressures were measured with a Stryker® pressure monitor. The absolute and differential compartment pressures were recorded. All patients were followed up for the duration of at least 8 months and until fracture union.

Results: The data collected was analysed using paired student t-test. There was no statistically significant difference (p> 0.05) in the preoperative mean compartment pressures for both groups when all the four compartments were measured individually. The mean postoperative measurements were higher (range 9–10 mmHg) in all four compartments in the traction group. This was statistically significant (p< 0.05). None of the pressures reached the critical level as they were more than 30 mmHg below the diastolic pressure (differential pressure).

Conclusions: These results show that traction increases compartment pressures during intramedullary nailing of tibial shaft fractures. The group considered did not have compartment syndrome possibly due to less soft tissue injury. With greater soft tissue injury and greater preoperative compartment pressures, compartment pressures can reach a critical level necessitating decompression. We conclude that intramedullary nailing without traction reduces the chances of significant increase in compartment pressures and advocate the procedure be done without traction.

Introduction: Clavicular non-union, although rare, is a debilitating and often painful condition. The aim of our study was to assess the long-term functional and radiological outcome of clavicular non-unions treated with open reduction and bone grafting in a regional trauma unit. A total of 24 non-unions treated between 1994 and 2001 were retrospectively analysed using chart and radiological review and subsequently assessed with the American Academy of Orthopaedic Surgeons DASH questionnaire.

Results: There were 13 males and 10 females with a median age of 38 years (range 21–65). One patient had bilateral injuries. The average time from injury to operation was 10.3 months (range 3–29) and the average follow-up post-operatively was 42.1 months (range 6–75). All patients were treated using a DCP or reconstruction plate with autogenous bone grafting. Twenty-two of the 24 non-unions eventually healed. The plate was eventually removed in 3 cases all due to pain. Analysis of the DASH upper limb scoring assessment indicated a slightly higher level of disability in the treated group than found in the normal population, but this was not significant and the procedure proved successful and well tolerated by most patients.

Conclusion: We conclude that the long-term outcome results of this procedure indicate it to be a well-tolerated and successful operation in treating the disability and pain associated with clavicular non-union. Most patients return to a daily level of function close to the general population.

Abstract: The importance of nerve root inflammation accompanying disc herniation and its contribution to symptomatology was first proposed in the 1950’s. This encouraged the widespread administration of (percutaneous) epidural steroid injections in the non-surgical treatment of acute and chronic lumbar Radicular pain. It also prompted the local application of steroid preparations directly onto the nerve root at the time of disc compression.

The literature supporting this latter practice however, is scant and equivocal. A randomised double blind prospective study was therefore carried out to evaluate the benefits of epidural steroid application at the time of lumbar disc decompression. 50 consecutive patients undergoing elective lumbar discectomy were enrolled. Patients in the study group (n=25) received 20mg of tri-amcinolone acetonide, applied directly to the decompressed nerve root. The control group (n=25) received an equal volume of saline. Intraoperative analgesia was standardised and postoperative pain was measured by a 10cm visual analog pain scale at 2, 6, 12, 25 and 72 hours. Standardised post-operative analgesic protocols were established and the amounts of consumed analgesics were determined.

Statistical analysis was performed using the Mann-Whitney test. No statistically significant difference was noted in either pain score, analgesic consumption at 24, 38 or 72 hours or length of hospital stay, between the steroid treatment or control groups. This suggests that local epidural steroid administration after lumbar disc decompression offers no therapeutic advantage over mechanical decompression alone.