Lessons Learned from the Management of Complex Intra-Articular Fractures at the Base of the Middle Phalanges of Fingers

The use of dynamic traction splintage is established in the treatment of complex intra-articular phalangeal fractures. Several different systems have been used and we report our experience with one of these, the Pins and Rubber Traction System. A cohort of 14 patients with complex intra-articular fractures at the base of the middle phalanges of the fingers were treated and assessed prospectively over a 2.5-year period (mean, 20 months; range, 7–28 months). The mean active range of motion regained, at the proximal interphalangeal joint, was 74° (range, 0–100°). The mean total active motion of the injured digit was 196° (range, 40–275°). Refinements in the regime are suggested as a result of this investigation.

Japanese Inward Investment in the Northeast of England: Reassessing ‘Japanisation’

The notion of ‘Japanisation’ is evaluated by examining the relationship between nationality and the adoption of particular kinds of managerial and work practices amongst inward investors in northeast England. Information is derived from an extensive postal questionnaire survey followed by a more intensive qualitative survey of inward investor plants. The postal survey shows that the new practices have been widely adopted in plants of all nationalities, although rates of adoption are higher for the Far Eastern group. The in-depth interviews reveal, however, that there are important variations in the ways in which these new practices are applied. It is argued that these variations cannot be understood in terms of ‘nationality’. Rather, they are associated with differences in production processes and the segmentation of labour based on gender, age, and skill. In the light of these findings, the significance of the term ‘Japanisation’ for regions and regional policy is considered.

Efficacy of ADCON-T/N after primary flexor tendon repair in Zone II: a controlled clinical trial

A prospective double-blind, randomized, controlled clinical trial was conducted to assess the use of ADCON-T/N after flexor tendon repair in Zone II. Forty-five patients with 82 flexor tendon repairs in 50 digits completed the study. ADCON-T/N was injected into the tendon sheath after tenorrhaphy in the experimental group while the control group was not treated with ADCON-T/N. ADCON-T/N had no statistically significant effect on total active motion at 3, 6 and 12 months but the time taken to achieve the final range of motion was significantly shorter in treated patients. ADCON-treated patients had a higher rupture rate but this was not significant.

Shoulder function following the loss of the latissimus dorsi muscle

A study of shoulder function was carried out in a group of 19 male patients who had their latissimus dorsi muscle removed as a free flap. A control group was examined to obtain data for the normal range of movement and power at the shoulder. Only a few patients had any subjective impairment of shoulder function; 13 of our 19 patients had a complete range of movement at the shoulder. There was no significant difference in power between the patient group and the control group when dominant and non-dominant sides were considered separately (p greater than 0.05). Patients who had surgery carried out more recently and patients with a scar contracture had a significantly higher disability score. The latter group also had a greater deficit in range of movement at the shoulder (p less than 0.05). Most patients encountered no difficulty whatever with their occupational and sporting activities. Our results support the view that the latissimus dorsi muscle is totally expendable and that there is no significant functional loss at the shoulder, either in casual or in forceful activities.

Bizarre posture and movement disorder with third ventricle astrocytoma

An eight-year-old girl presented with a bizarre posture and gait and was diagnosed as having hysterical astasia-abasia. She walked with marked lordosis and head hyper-extended, and would walk backwards across the room to a bed or chair for support. She had a midline astrocytoma and the disorder was relieved with removal of the tumour. The unusual symptomatology accompanying many midline lesions is re-emphasized.