Biomedical subjects
Publications and source records attributed to S N Harrop.
"Toddler's fracture" can be difficult to diagnose but should be suspected whenever a child presents to the accident and emergency department with a limp or fails to bear weight on the leg. Irritable hip and subacute osteomyelitis must feature in the differential diagnosis. The history may or may not include an obvious traumatic episode. Rather than fracture, elastic bowing of the bone and consequent periosteal stripping may explain symptoms in some cases.
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Review of a consecutive series of the elderly patients who presented unheralded to the Accident and Emergency Department of the Royal Gwent Hospital showed that a relative minority (11%) were difficult to manage because they had no obvious acute medical condition or injury which qualified them for admission by the firms to whom they were first referred. The difficulty was compounded by the shortage of geriatric beds. Judicious use of short-stay ward beds in the accident and emergency department relieved pressure on beds elsewhere and allowed a short space of time in which preparation could be made for the patient's further care in the community. Elderly patients were removed quickly from the stretcher area of the accident and emergency department to the quieter surroundings of the short-stay ward, where their immediate nursing requirements could be readily met. It was not then necessary for them to be on a trolley for hours while junior doctors haggled on the telephone or nurses were too busy to administer food, drink and bedpans.
Fifty eight coal miners attended the Royal Gwent Accident and Emergency Department with serious hand injuries over a three year period. The commonest cause of the injuries was falling rock or coal from the pit roof crushing the hand and the commonest type of injury was the crushed, compound fracture of the terminal phalangeal area of the digit, with or without pulp loss. Records of the time off work with the injury were obtained in 52 miners. Only seven (13%) returned to work within one month. Of 40 individual distal phalangeal injuries reviewed after one year, only four (10%) had normal sensation and full movement at the distal joint. Nevertheless, only seven miners (13%) had to alter their initial occupation at the mine and move to lighter duties.
This study of industrial hand injuries describes the nature of commonly encountered injuries, the significance of hand dominance, and the circumstances contributing to the cause of injury. Although many histories were unique, and the contributory factors correspondingly diverse, some recommendations can be made for future prevention and investigation.
In order to illustrate our current pattern of use, 50 patients were reviewed who were examined by computerized tomography (CT) of the head during admission through the Accident and Emergency (A & E) Department. Fourteen (28 per cent) had no history of head injury but exhibited diminished conscious level, epilepsy, headache, or hemiplegia. The 36 cases of head injury were analysed in order to see whether they met certain criteria proposed by other authors, and to suggest the advantage to be gained when CT was available in a district general hospital (with teaching status).
In the sera studied, fatal motorcycle accidents were more often the fault of a motorcyclist than of another road user. Pillion passengers contributed to some accidents, and the law should restrict the consumption of alcohol by pillion riders as well as by motorcycle drivers. Injury to the brain or brain stem was a major cause of death despite crash helmets. Haemorrhage might have been successfully arrested in some patients who survived to reach hospital, though this might not have guaranteed survival. The potential reduction in mortality is discussed in relation to injury severity score. A saving in life is more likely to accrue from preventive means than from improved rescue and treatment facilities.