1. Seventy-five patients sustained fractures of the pelvis with associated soft-tissue complications. Twenty died, and of these, thirteen died within forty-eight hours of admission to hospital.

2. The initial resuscitation and clinical assessment of these patients are discussed, and attention is drawn to the significance of the concomitant retroperitoneal haematoma as a cause of oligaemic shock, and as a dissembler of internal visceral injury.

3. The morphological fracture patterns are classified into six categories, but the fracture patterns are not correlated with specific visceral injuries.

4. Forty-six patients sustained urinary tract injuries. Of these, nineteen had suffered rupture of the urethra; fourteen had rupture of the bladder; two had both urethral and vesical disruption, and one patient had a torn ureter. The diagnosis and management of these injuries is discussed.

5. Twelve patients had a traumatic laceration or perforation of the ano-rectum. Nine of these patients had associated urethral or vesical injuries.

6. Four patients were involved in accidents and sustained pelvic fractures while in the last three months of pregnancy. The tragic outcome of this combination of circumstances is noted.

7. Attention is drawn to peripheral nerve injuries in association with pelvic fractures, and the difficulty of localising these lesions is stressed.

8. Eight instances of damage to the abdominal parietes are recorded. Four patients suffered skin and soft-tissue loss, two patients had diaphragmatic disruptions and two patients had abdominal wall dehiscences.

9. Major accident victims frequently have multiple injuries. This series of patients has been analysed to draw attention to the association of pelvic fractures with bizarre visceral injuries.

1. An account is given of twenty patients who had sustained accidental division of one or more foot tendons (other than tendo calcaneus).

2. Severe deformities occur when these injuries are neglected in children.

1. Three cases of traumatic thrombosis of the iliac arteries and one case of a false aneurysm of the internal iliac artery following closed injuries are described.

2. Results of the treatment of these cases are discussed.

Over a period of twenty years a small number of patients, thirty-one, have been seen who suffered injuries of the infraclavicular brachial plexus as a direct result of skeletal injury in the region of the shoulder joint.

Except for isolated circumflex nerve injuries the prognosis is generally good whatever part of the plexus is damaged. The treatment is conservative and its two most important features are prevention of stiffness of joints and the control, by regular galvanic stimulation, of denervation atrophy of muscle during the often prolonged period before recovery becomes apparent.

1. Evidence is presented that certain types of cervical spine injury are due mainly to lateral flexion forces.

2. These injuries are often complicated by a brachial plexus lesion as well as a lesion of the spinal cord.

3. It is not always easy to detect the brachial plexus injury when the patient is first seen.

4. In the cases reviewed there has been little or no recovery of cord function, and the existence of a brachial plexus injury has, of course, made rehabilitation much more difficult.

5. The practical importance of recognising the mechanism of this type of injury is that treatment which will cause further separation of the vertebrae is inadvisable.

1. Compression forces are mainly absorbed by the vertebral body. The nucleus pulposus, being liquid, is incompressible. The tense annulus bulges very little. On compression the vertebral end-plate bulges and blood is forced out of the cancellous bone of the vertebral body into the perivertebral sinuses. This appears to be the normal energy-dissipating mechanism on compression.

2. The normal disc is very resistant to compression. The nucleus pulposus does not alter in shape or position on compression or flexion. It plays no active part in producing a disc prolapse. On compression the vertebral body always breaks before the normal disc gives way. The vertebral end-plate bulges and then breaks, leading to a vertical fracture. If the nucleus pulposus has lost its turgor there is abnormal mobility between the vertebral bodies. On very gentle compression or flexion movement the annulus protrudes on the concave aspect–not on the convex side as has been supposed.

3. Disc prolapse consists primarily of annulus; it occurs only if the nucleus pulposus has lost its turgor. It then occurs very easily as the annulus now bulges like a flat tyre.

4. I have never succeeded in producing rupture of normal spinal ligaments by hyperextension or hyperflexion. Before rupture occurs the bone sustains a compression fracture. On the other hand horizontal shear, and particularly rotation forces, can easily cause ligamentous rupture and dislocation.

5. A combination of rotation and compression can produce almost every variety of spinal injury. In the cervical region subluxation with spontaneous reduction can be easily produced by rotation. If disc turgor is impaired this may occur with an intact anterior longitudinal ligament and explains those cases of tetraplegia without radiological changes or a torn anterior longitudinal ligament. The anterior longitudinal ligament can easily be ruptured by a rotation force and in my experience the so-called hyperextension and hyperflexion injuries are really rotation injuries.

6. Hyperflexion of the cervical spine or upper thoracic spine is an anatomical impossibility. In all spinal dislocations a body fracture may or may not occur with the dislocation, depending upon the degree of associated compression. In general, rotation forces produce dislocations, whereas compression forces produce fractures.

1 . A specific mechanism of injury can produce a tear of the articular disc of the wrist without any associated bony lesion.

2. Torn discs have been found associated with Colles's fractures and with dislocation of the inferior radio-ulnar joint.

3. The injury gives rise to clear-cut symptoms and definite physical signs.

4. Operation in fourteen cases has shown five types of tear of the disc.

5. Arthrographs of the wrist are helpful in establishing the diagnosis.

6. In isolated tears removal ofthe disc relieves the symptoms and does not prejudice function.

7. If there is other joint injury, removal of the disc cannot be expected to give as satisfactory a result.

1. Twenty-seven patients with a Brown-Séquard syndrome resulting from trauma have been studied, fourteen of the left side of the cord and thirteen of the right. There were sixteen gunshot wounds and eleven closed injuries.

2. The prognosis for recovery is much better than the initial catastrophic nature of the symptoms and signs would indicate.

3. The pattern of recovery is discussed in detail and the long and rather tedious course of the treatment is indicated.

4. Spasticity on the side worse affected still presents a difficult problem, but a less severe one than that presented by flaccid paralysis.

1. Two cases of arterial damage complicating shoulder injuries are reported.

2. The treatment is described and the importance of early diagnosis is stressed.

3. Operation was indicated in both cases by developing ischaemia in spite of conservative measures.

1. The literature on paraplegia complicating hyperextension injuries of the cervical spine is reviewed, and the lack of any definite explanation of the mode of interference with cord function is noted.

2. A case is described in which a detailed dissection of the post-mortem specimen was carried out. On the basis of the findings it is suggested that one cause of the suppression of cord function in such injuries is thrombosis of the spinal arteries and liquefaction-necrosis of the cord.

We have assessed the efficacy of free nerve grafts in 90 cases of brachial plexus injury. Relatively good recovery of the elbow flexor and extensor muscles and of those of the shoulder girdle was found but recovery of the flexors and extensors of the forearm and of the intrinsic muscles of the hand was extremely poor.

Poor results were found when spinal nerve roots seemed normal to the touch and appeared intact but had abnormal somatosensory evoked potentials or myelography. Recovery of the deltoid and infraspinatus muscles was better when injury had occurred to the circumflex and suprascapular nerves rather than to the plexus itself, perhaps because these nerves were explored in their entirety to determine the presence of multiple lesions.

It is important to visualise the entire nerve thoroughly to assess the overall condition. Thorough exploration of the plexus and the use of intraoperative recording of somatosensory evoked potentials are essential.

Serious neck injury in rugby football is becoming more common, especially in schoolboys. We report five who presented with spinal cord damage between 1977 and 1983, two in the 1982-83 season. The mechanisms of injury, the treatment, and the outcome are discussed. We suggest measures to reduce the incidence of this most serious injury and draw attention to the appropriate management in the critical phase directly after injury.

1. Three new cases of injury to main arteries at orthopaedic operations are described, and a follow-up of two previously described cases is given. The rarity of these accidents is a credit to those engaged in orthopaedic surgery, for many orthopaedic operations are done very close to great vessels, and often under the bloodless conditions of a tourniquet. Nevertheless, it is well to have the risk of great vessel injury in mind because such an accident, although rare, may be a serious threat to life or limb.

2. It is important to repair the damaged artery rather than ligate it because the risk to the growth or viability of the limb is lessened.

3. The aim should be a return to full function with as near normal a vascular anatomy as possible.