A plea for simplicity in the classification of ankle fractures

1. Ashurst and Bromer's classification of ankle fractures is a useful one, but falls into the complexities of subdivision into sequential progression of severity, i.e. ‘degrees’ of fracture.

2. A similar criticism can be made of the Lauge-Hansen classification which has an added semantic disadvantage. Doubts are also cast upon the validity of the direct application of experimental results in cadaveric specimens to a clinical series.

3. A third classification, essentially a modified form of those preceding it but with both an anatomical and a functional basis is presented, in the belief that it can provide evidence of: (a) the mechanism of production and hence the achievement of reduction; and (b) the recognition of significant ligamentous damage, i.e. the recognition of major from minor, stable from unstable injuries—when used in association with radiographs taken while straining the ankle under anaesthesia.

4. An Appendix to the paper (pp. 210-211), giving a more detailed account of our revised classification, is included.

VENOUS DRAINAGE IN OSTEOARTHRITIS OF THE HIP

1. Thirty-seven hips with osteoarthritis underwent phlebography before intertrochanteric osteotomy. The results of this study were reported previously.

2. Thirty-two of the hips were studied and have had a clinical, radiological and phlebographic examination about one year after operation. Three of these were excluded because of technical failures.

3. Twenty-four hips had a normal pattern of venous drainage after operation; of these only two had normal patterns before operation and the rest had had many abnormalities of venous drainage. These hips had been completely or considerably relieved of pain at rest and on activity.

4. In the other five hips, although the venous drainage pattern was still abnormal, in only one was there significant deterioration in the venous pattern; in this group there was also some alleviation of rest pain.

5. The findings are discussed in relation to the pathology of osteoarthritis and the possible influences of intertrochanteric osteotomy.

6. The pain produced by the injection of radiopaque material into the femoral head was similar to the rest pain. This finding is discussed in relation to venous obstruction and congestion.

PHLEBOGRAPHY IN OSTEOARTHRITIS OF THE HIP

1. Phlebography has been done on seven hips showing no radiological evidence of osteoarthritis. The findings largely confirm the work of previous authors.

2. Thirty-seven osteoarthritic hips have been examined in the same way. As the degenerative process worsens radiologically so the pattern of venous drainage deviates further from the so-called normal.

3. An attempt is made to explain the phlebographic findings in the light of known facts of the pathology of the disease.