Broad Arm Sling Research Articles

Broad Arm Sling vs Figure of 8 Bandage: The Better Choice in Conservative Management of Middle Third Clavicle Fractures in Indian Population.

BackgroundA prospective randomised trial was conducted to compare the results of conservative management of middle-third clavicular fracture using the figure of 8 bandage and broad-arm sling.Methods296 patients with middle-third clavicle fracture were included in the study conducted between March 2017 and January 2020. 152 patients were managed with figure of 8 bandage and 144 patients were managed with a broad arm sling. Results were evaluated based on clinical, radiological and functional outcomes. Visual analogue scale (VAS) for pain was used to evaluate the clinical outcomes, whereas radiological outcomes were assessed with non-union, malunion, clavicle shortening and time to union. Disability of Arm, Shoulder and Hand score (DASH), Constant score and Nottingham Clavicle Score were used to assess functional outcomes.ResultsThe broad arm sling group showed a significantly better VAS score in the first 4 weeks. DASH score was significantly superior in the broad arm sling group in the initial 4 weeks, but with similar outcome thereafter. Constant scores showed a good outcome for both groups at the final follow-up, whereas the Nottingham Clavicle Score was significantly superior in the broad arm sling group at the 2 year follow-up. A satisfactory outcome was achieved with respect to the radiological parameters, without any significant difference between the 2 groups. Incidence of malunion was significantly higher in figure of 8 bandage group.ConclusionsBroad-arm sling proves to be a better modality of management for middle-third clavicular fractures in terms of ease of application, pain relief, incidence of malunion, and functional outcomes.

105 The Mustaq Method: Could This be The Simplest Shoulder Dislocation Reduction Method?

Abstract Introduction The Mushtaq Method is a new shoulder reduction technique. It is a simple, reliable, and less traumatic time modulated procedure. Method Patients are placed in the supine position if plausible. Fully adducting the affected arm with the elbow at right angle. The practitioner applies gentle traction above the elbow with the other hand placed deep into the axilla, palpation of the humeral head is followed by lateral pressure resulting in a successful relocation. Internal rotation and a broad arm sling complete the technique. No assistants are needed, and simple analgesia was often enough. Results 95% had a successful reduction within 5 minutes. 75% required analgesia alone, and no periprocedural complications were observed. Conclusions With so many options already, available it is essential to understand what dictates the success and failures of these methods. We have a new, safe, easy to use method requiring minimal force. We hope to increase our cohort size in the future to draw firm conclusions.

Drawbacks of conservative treatment of proximal humerus fractures in elderly

AbstractBackground Fractures of proximal humerus are popular in older people . About ¾ of proximal humerus fractures occur in patients older than sixty. Several methods of internal fixation and arthroplasty are used. However conservative treatment continues to be used in this age group, although some complications of conservative management limit its indications.Objective To assess the outcomes of conservative treatment of proximal humerus fractures in elderly patients.MethodsIt is a retrospective study of 30 elderly patients (over 50 ys) suffered from proximal humerus fractures and received conservative treatment using broad arm sling. All patients were subjected to regular clinical and radiological examination to evaluate time of union, range of motion, residual pain and complications.Results The average follow up time was 6 months. Nine cases(30%) showed nonunion while 11 cases(37%) showed delayed union after 3 months. The results showed8 cases (27%) with poor range of motion and 13 cases(43%) with acceptable range of motion while 9 cases (30%)showed good range of motion. As regard Pain evaluation,8 cases (27%) with moderate pain while 13 cases (43%) with mild pain and 9 cases (30%) showed no pain. There were 4 cases (13%) of malunion, 3 cases (10%) of avascular necrosis of humeral head, 4 cases (13%) of inferior subluxation of the humeral head and 2 cases (7%) of posttraumatic arthritis.Conclusion Conservative treatment of proximal humerus fractures in elderly patients is associated with significant incidence of unsatisfactory outcomes and should be limited only to patients unfit for surgery.

Nonoperative Treatment Compared with Plate Fixation of Displaced Midshaft Clavicular Fractures in Adults

AbstractBackground: Fracture clavicle is one of the most common fractures, it constitutes about 4% of all fractures. 76% of clavicular fractures are fracture of the mid shaft. Clavicular fractures have classically been treated conservatively with favourable results. However, unsatisfactory results were found in recent clinical series as nonunion and malunion. The debate is still present between conservative and operative treatment of displaced fracture clavicle. This study is meant to compare the outcomes of nonoperative conservative treatment and operative treatment with plate fixation of the completely displaced midshaft clavicular fractures to clarify the merits and possible disadvantages of each method.Aim of Study: Comparison between the outcomes of the non-operative and operative treatment of displaced mid-shaft clavicular fracture to reveal the advantages and disadvantages of each method to refine the indications of each method.Patients and Methods: This study was performed on fourty adult patients with mid-shaft clavicular fracture, sub grouped randomly in two matched groups regarding age, sex and type of fracture. 20 patients (Group A) were treated non-operatively by immobilization with broad arm sling and 20 patients (Group B) were treated operatively by open reduction and internal fixation (ORIF) with plate and screws. Patients were collected from orthopedic surgery department, Tanta University Hospitals, followed up at a period of 18 months and assessed using the constant shoulder score (CSS).Results: Results were functionally satisfactory in 90% of group A patients and in 70% of group B patients according to CSS. ORIF was attended with higher complication rate, inferior overall outcome and more unsatisfied patients.Conclusions: According to the study results, non-operative treatment by broad arm sling is the preferred line of treatment in solitary closed uncomplicated mid-shaft clavicular fractures. ORIF is recommended in cases of associated scapular neck fracture “floating shoulder”.

Surgical neck humerous fracture- A case report

Humerus fractures are reported to be the third most common osteoporotic fracture. There is an increasing incidence of humerus fracture rates. We reported a case of surgical neck humerous fracture in 46 year old male patients which was managed conservatively with a broad arm sling.

MIDSHAFT CLAVICLE FRACTURE

Introduction: Fracture of clavicle is common, occurring most commonly inmales accounting for approximately 2.5%of all fracture presenting to orthopedic surgeon.1 Thisstudy has been conducted to compare the broad arm sling and figure of eight bandage in thefirst 21 days of treatment with primary outcome measure of pain and disability. Study Design:Comparative study. Setting: Department of orthopedic surgery, Dow International MedicalCollege, Dow University hospital. Period: February 2015-2016. Material and Methods: 60eligible patients with a mean age of (15-60 years) were randomized to conservative treatmentwith either a broad arm sling or figure of eight bandage. After detailed counseling taking informedconsent we did non stratified randomization in blocks of two using the sealed envelope method.Patients were kept in strict follow up to complete the outcome measures the next day and onday seven, fourteen and twenty one. On each visit a Performa was filled known as SPADI havingtwo components of pain and disability and VAS on day one, seven, fourteen and twenty one.Results: Seventy patients were enrolled initially, out of them ten patients were dropped outdue to different reasons. Of the remaining 60 patients 30 were treated with broad arm sling and30 were treated with figure of eight bandage. The two groups were randomized fulfilling theinclusion criteria. The Mean VAS on the first day of treatment in the broad arm sling group was5.433 SD 1.04 (p= 0.034, 95% CI 0.10 -2.46) where as in figure of eight group was 8.9 (SD 10.8).On subsequent visits (Day 7,14,21) VAS of broad arm sling was 3.83, 1.40,1 whereas figure ofeight was 5.76, 4.3, 3.469. This result clearly shows good pain control in broad arm sling groupas compared to the figure of eight group. The mean SPADI on the first day of treatment was94.52(SD 2.273) in broad arm sling group, on the other hand it was 93.87(SD 2.239) in figure ofeight group. In follow up visits of day 7, 14 and 21 score was as follows in broad arm group 3.83(SD 0.79), 1.4(SD 0.49), 1(SD 0.0), it was 5.76(SD 1.04), 4.3(SD 0.740), 3.4(SD0.68) in figure ofeight group. It also shows better result in terms of pain and functional outcome. Conclusion:Fracture clavicle is still managed conservatively in majority of the cases, either with the figure ofeight bandage or polyarm sling. Patient’s outcome in terms of pain management and functionalrange of motion in poly arm sling is better than figure of eight bandage.

COMPARISON OF POLY ARM SLING AND FIGURE OF EIGHT BANDAGE

Introduction: Fracture of clavicle is common, occurring most commonly inmales accounting for approximately 2.5%of all fracture presenting to orthopedic surgeon.1 Thisstudy has been conducted to compare the broad arm sling and figure of eight bandage in thefirst 21 days of treatment with primary outcome measure of pain and disability. Study Design:Comparative study. Setting: Department of orthopedic surgery, Dow International MedicalCollege, Dow University hospital. Period: February 2015-2016. Material and Methods: 60eligible patients with a mean age of (15-60 years) were randomized to conservative treatmentwith either a broad arm sling or figure of eight bandage. After detailed counseling taking informedconsent we did non stratified randomization in blocks of two using the sealed envelope method.Patients were kept in strict follow up to complete the outcome measures the next day and onday seven, fourteen and twenty one. On each visit a Performa was filled known as SPADI havingtwo components of pain and disability and VAS on day one, seven, fourteen and twenty one.Results: Seventy patients were enrolled initially, out of them ten patients were dropped outdue to different reasons. Of the remaining 60 patients 30 were treated with broad arm sling and30 were treated with figure of eight bandage. The two groups were randomized fulfilling theinclusion criteria. The Mean VAS on the first day of treatment in the broad arm sling group was5.433 SD 1.04 (p= 0.034, 95% CI 0.10 -2.46) where as in figure of eight group was 8.9 (SD 10.8).On subsequent visits (Day 7,14,21) VAS of broad arm sling was 3.83, 1.40,1 whereas figure ofeight was 5.76, 4.3, 3.469. This result clearly shows good pain control in broad arm sling groupas compared to the figure of eight group. The mean SPADI on the first day of treatment was94.52(SD 2.273) in broad arm sling group, on the other hand it was 93.87(SD 2.239) in figure ofeight group. In follow up visits of day 7, 14 and 21 score was as follows in broad arm group 3.83(SD 0.79), 1.4(SD 0.49), 1(SD 0.0), it was 5.76(SD 1.04), 4.3(SD 0.740), 3.4(SD0.68) in figure ofeight group. It also shows better result in terms of pain and functional outcome. Conclusion:Fracture clavicle is still managed conservatively in majority of the cases, either with the figure ofeight bandage or polyarm sling. Patient’s outcome in terms of pain management and functionalrange of motion in poly arm sling is better than figure of eight bandage.

Middle third clavicular fractures: to fix or not to fix?

Clavicular fractures are common injuries with the incidence quoted between 29 and 198 per 10 000 population per year.1 They are classified into three types:- Type 1: Middle third Type 2: Lateral third (distal to coraco-clavicular ligament) Type 3: Medial third The majority of fractures (> 70%) are type 1. Traditionally these fractures have been treated conservatively with initial immobilisation in a broad arm sling, collar and cuff, or figure of eight strapping. The results of conservative treatment were generally felt to be satisfactory. Nordqvist et al2 in Malmo reviewed 225 mid clavicular fractures at an average of 17 years from injury. The great majority (185/82%) were symptom free. Thirty-nine (17%) had moderate pain and one patient was classified as poor. Fifty-three of the patients had a malunion and seven had nonunions. Forty of the patients with malunited fractures and three with nonunion were rated as good. Fagg1 reviewed the available literature and found an incidence of nonunion of 7% in displaced mid shaft fractures at that time. Thormodsgard et al3 looked at patient satisfaction after non-operative management of clavicular fractures using the Disabilities of the Arm, Shoulder and Hand (DASH) classification. They looked particularly at clavicular shortening and found that patients with shortening of over 2 cm had the highest DASH scores indicating disability and dissatisfaction with their outcome after the injury. They looked at all types of clavicular fracture but found that DASH scores were higher in type 1 fractures. They concluded, “patients with midshaft clavicle fractures with shortening of greater than 2 cm may be good candidates for operative repair.” Murray et al4 assessed the significant risk factors for nonunion in 941 conservatively treated mid shaft clavicular fractures in adults. One hundred and twenty-five (13.3%) had clinical and radiological evidence of nonunion. …

G29(P) The management of children diagnosed with an uncomplicated clavicle fracture: broad-arm sling and written self-care information versus broad-arm sling and hospital outpatient follow-up

Background and objectivesIn July 2013 the Paediatric Emergency Department (ED) of a UK District General Hospital seeing approximately 30000 children per year aged under 16 years in the ED, began...

Management of Mason type 1 radial head fractures: a regional survey and a review of literature

Despite being the most common fracture around the elbow, the management of Mason type 1 radial head fractures lacks a clear protocol in literature. The aims of this study were to assess our practice of managing this injury and to create guidance for the management of these fractures based on literature review. We designed a survey investigating the practice of orthopaedic surgeons in the management of Mason type 1 fracture. The literature review was carried out looking for the best practice guidelines. Forty-nine surgeons (out of 56) responded, and mean duration of immobilisation was 11.69 days with the collar and cuff sling as the preferred method. 65.3% offered physiotherapy service to their patients. 20.4% recommended plain radiographic imaging follow-up. Mean duration of follow-up was 43.9 days. Decision to discharge the patient was mostly (77.6%) dependent on clinical improvement at time of last examination. 4.1% of treatment decisions were evidence based. We observed a wide variation in the management of this common injury. Based on the current literature, the best protocol for the management of type 1 radial head fractures should be joint aspiration, followed by immobilisation in a broad arm sling for 2 days. At the first outpatient visit, assessment of the collateral stability should be performed. Patients with stable elbows should be encouraged to stretch these beyond the painful range. Patients can be discharged at this stage with an advice to come back for a clinical and radiographic assessment if there is no improvement at 6 weeks.

Clavicle non-union: Autologous bone graft is not a necessary augment for internal fixation

Purpose The aim of this study was to report the outcomes of a series of patients with clavicle fracture non-union who had undergone open reduction and internal fixation using a contoured locking plate without the use of distant bone graft. Methods Patients were identified using the hospital database. Records were reviewed to determine basic demographics, operative findings, and radiological outcome. Patients were contacted and details about initial injury and treatment, and return to work and sport were recorded. Disabilities of Arm, Shoulder and Hand (DASH) for both operated and non-operated shoulders were completed. Results 15 patients with at least 6 months follow-up (average 12.4) were identified. The average age was 39 years. All patients were initially treated in a broad arm sling. All fractures were fixed with a pre-contoured locking plate and all went on to achieve clinical and radiological union. The average DASH on the operated side was 14.5 and 4.2 on the contralateral. All patients had returned to work and regular sport activities. One patient required plate removal due to local irritation. Conclusion The results of this small series suggest that use of distant bone graft is not necessary when performing open reduction and internal fixation for symptomatic non-union of the clavicle with appropriate preparation of fracture ends and adequate fixation.

Complications Associated With Clavicular Fracture

The objective of our literature review was to inform orthopaedic nurses about the complications of clavicular fracture, which are easily misdiagnosed. For this purpose, we searched MEDLINE (1965-2005) using the key words clavicle, fracture, and complications. Fractures of the clavicle are usually thought to be easily managed by symptomatic treatment in a broad arm sling. However, it is well recognized that not all clavicular fractures have a good outcome. Displaced or comminuted clavicle fractures are associated with complications such as subclavian vessels injury, hemopneumothorax, brachial plexus paresis, nonunion, malunion, posttraumatic arthritis, refracture, and other complications related to osteosynthesis. Herein, we describe what the orthopaedic nurse should know about the complications of clavicular fractures.

Backslab Versus Nonbackslab for Immobilization of Undisplaced Supracondylar Fractures

Immobilization of supracondylar fractures of the humerus, for 1 to 4 weeks in a backslab or a collar and cuff, produces good functional outcomes. This study assesses the pain associated with these 2 forms of immobilization. A randomized controlled trial comparing above-elbow posterior fiberglass slab and broad arm sling, with collar and cuff immobilization without plaster slab, was conducted at a children's hospital emergency department. Patients presenting with undisplaced supracondylar fractures were enrolled and reviewed after 2 weeks of immobilization. A daily diary was used during immobilization to assess pain, resumption of normal activity of the child, and parental satisfaction. Pain was assessed using a 100-mm visual analog scale. Fifty patients were enrolled, of whom 27 were randomized to a slab and 23 were randomized to a collar and cuff. Immobilization in a slab was associated with a reduction in time to resumption of normal activity, while immobilized in the device, with a median of 2.0 days (interquartile range [IQR], 1.0-5.0 days) versus 7.0 days (IQR, 3.0-13.0 days; P = 0.01). For the slab group, the median duration of pain was 4.0 days (IQR, 1-8.0 days) versus 6.0 days (IQR, 5.0-9.5 days) for the collar and cuff group (P = 0.07). Median daily pain severity was 28 mm for the slab group versus 33 mm for the collar and cuff group (P = 0.21). Moreover, 96% of parents in the slab group and 83% in the collar and cuff group would use the immobilization again (P = 0.17). For supracondylar fractures, use of an above-elbow posterior slab produces shorter duration of pain and reduces the time taken to become active again.

Late Diagnosis of Locked Posterior Dislocation Of The Shoulder Associated With Lateral Clavicle Fracture

This case report brings to our attention a rare instance of a missed posterior shoulder dislocation, along with a clavicular fracture on the same side. These dislocations have a high chance of being overlooked on their own and there are no previous reports of such an injury in combination with fracture of the clavicle on the same side. This article seeks to highlight the importance of having a high degree of suspicion and diligent examination of the patient. INTRODUCTION Fractures of the distal clavicle are common injuries. Posterior dislocation of the shoulder is rare and accounts for approximately 2% of dislocations about the shoulder (3). The diagnosis of posterior dislocation of the shoulder is frequently missed (2). We are unaware of any previous reported cases of a combination of these injuries PRESENTATION A 56 year old right hand dominant male had a collision on his mountain bike causing him to fall over the handle bars. He sustained an injury to his right shoulder and attended the Emergency Department. His presenting complaint was pain around his right shoulder and a swelling over the lateral aspect of his clavicle. He sustained no other injuries and was noted to be distally neurovascularly intact. An anterior posterior radiograph was performed minimally displaced fracture of the lateral aspect of the right clavicle was diagnosed. The patient was placed in a broad arm sling and referred to fracture clinic follow up. At the first fracture clinic appointment (1 week post injury) the patient re-examined and radiographs reviewed. The diagnosis of a fracture of the lateral aspect of the right clavicle was confirmed. The patient remained in the broad arm sling and was advised to commence active mobilisation of the elbow and pendular exercises of the shoulder. The patient was reviewed 4 weeks post injury. At this point the patient complained of a stiff right shoulder. A repeat anterior posterior radiograph demonstrated callus formation at the clavicle fracture site. The patient was referred to physiotherapy for mobilisation. At 8 weeks post injury, the shoulder stiffness persisted and it was decided to persist with physiotherapy. At 14 weeks post injury a further fracture clinic review occurred. The patient continued to complain of stiffness in the right shoulder. Examination revealed a loss of extension and abduction restricted to 45 degrees. Repeat radiograph demonstrated a united clavicle fracture and tentative diagnosis of a locked posterior dislocation was made. The patient was referred to the upper limb clinic. 22 weeks post injury; the patient was reviewed in the upper limb clinic. The diagnosis of united clavicle fracture and a locked posterior dislocation was confirmed. An MRI scan revealed an intact rotator cuff. The diagnosis was discussed with the patient and an open reduction and tuberosity transfer operation of the right shoulder performed. The patient was assessed by means of a Constant score preoperatively and at 6 and 12 months post-operatively. The Constant score assess pain, activities of daily living, range of movement and power. The maximum possible score is 100. Pre-operatively the patient achieved a score of 26; this had improved to 48 and 64 at 6 and 12 months post-operatively. The patient is currently satisfied and due for review at 24 months post-operation. Late Diagnosis of Locked Posterior Dislocation Of The Shoulder Associated With Lateral Clavicle Fracture 2 of 3 OUTCOME MEASURES Preoperative and Post operative Constant score.

Ipsilateral sternoclavicular joint dislocation and fracture of the medial end of the clavicle

A 30-year-old male on holiday abroad, fell from hismountainbikewhilsttravellingatspeed,injuringhisright shoulder. Admission radiographs confirmed thepresence of a medial clavicular fracture and he wastreated conservatively using a broad arm sling(Fig. 1).Three weeks later, on his return from holiday,further radiographs were taken due to ongoing painand swelling. In addition to the fracture, a disloca-tion of the sternoclavicular joint was identified. Acomputedtomography (CT) scan of theSCJs demon-strated lateral displacement of the right clavicleandassociatedfracturesofthetransverseprocessofthe first thoracic vertebra and the first rib (Fig. 2).The senior author elected to stabilise the clavicularfracture and the SCJ surgically.Due to the small size of the medial fracturefragment and the need to reconstruct the SCJ,the clavicular fracture was fixed using a six-holesmall fragment reconstruction plate. This gave suf-ficient space for the SCJ to be stabilised using a freepalmaris longus graft harvested from the patient’sipsilateralarm.Thegraft wastakenthroughaseriesof small stab incisions, and fed through holes madein the medial end of the clavicle and the anteriortable of the manubrium. The graft was secured in afigure of eight configuration using absorbablesutures, in effect reconstructing the anterior jointcapsule (Fig. 3).The patient was discharged from hospital thefollowing day and his shoulder was immobilised ina broad arm sling for 6 weeks. Thereafter he wasencouraged to gently mobilise his shoulder and by 3months following the procedure he had regained asymptom free full range of movement. At this stagehe was permitted to carry loads in his right handwithout restriction (Fig. 4).

Post-traumatic duplication of the clavicle

A 14-year-old boy presented with fracture of lateral end of clavicle following a fall on right shoulder. Plain radiographs confirmed that the lateral fragment is in anatomical position with respect to coracoid and acromion and the medial fragment is displaced postero-superiorly (Fig. 1). This was treated conservatively in a broad arm sling. Six weeks post-injury, radiographs showed that the fracture has healed with formation of a Y-shaped clavicle (Fig. 2). Patient complained of pain and limitation of movement of shoulder due to prominent medial fragment of the clavicle, which could be felt subcutaneously. Because of these symptoms, surgical excision of the prominent bone from the medial fragment was offered.

INCOMPLETE BRACHIAL PLEXUS INJURY CAUSED BY MASSIVE CALLUS FORMATION IN A HORSE RIDER - A RARE COMPLICATION FOLLOWING CLAVICULAR FRACTURE

HISTORY A 35 year old jockey presented to our Accident & Emergency with a history of fall off a horse sustaining injuries to the chest and right shoulder. No history of Head injury. PHYSICAL EXAMINATION GCS 15/15, marked tenderness over the middle third of right clavicle and tenderness over the 7th,8th and 9th ribs on the right side with decreased air entry on the same side. Patient had dyspnoea. No neurological deficit TEST AND RESULTS X ray, right shoulder revealed a displaced fracture of the middle third clavicle and pneumothorax seen on chest x ray. INITIAL TREATMENT Broad arm sling, insertion of intercostal drainage tube. Patient discharged two weeks later with no neurology. REVIEW 2 months Swelling over the right clavicle and gradual progressive weakness of the entire upper limb. PHYSICAL EXAMINATION Nontender swelling over the right clavicle, marked weakness of shoulder abduction and wrist and finger extension. FURTHER TEST AND RESULTS X-ray revealed union of the fracture with massive callus. Nerve conduction study showed a postganglionic brachial plexus injury. WORKING DIAGNOSIS Secondary brachial plexus injury due to fracture clavicle. TREATMENT AND OUTCOMES Resection of part of the clavicle and the encroaching callus from the undersurface of clavicle. Patient had no improvement in the first week after surgery, but improved after the third week and had full recovery by the fifth month. CONCLUSION Neurological complications in clavicle fractures are uncommon. As a primary lesion it is caused by trauma itself. Secondarily neuology may develop due to massive callus compressing the brachial plexus. Resection of the clavicle would appear to be the treatment of choice to relieve compression. Only a few reports of the injury are available in the literature. This case is reported for its rarity.

Fracture of the clavicle associated with a rotatory atlantoaxial subluxation

A 6-year-old girl tripped over a football and landed on her right shoulder. Clinical examination revealed a fracture of the right clavicle with torticollis. An X-ray of the right shoulder confirmed the angulated midshaft fracture of the clavicle. The patient was discharged with analgesics and a broad arm sling. She returned to the casualty department the next day with headache and vomiting. She was sent home on analgesics. Following a further re-attendance the next day she was noted to have a ‘Cock–Robin position’. Although the motion of the cervical spine was severely restricted in all directions with marked nuchal muscle spasm, the results of the neurological examination were normal. X-rays of the cervical spine then showed AARS (Fig. 1), which was confirmed, on computed tomography (CT) scan (Figs. 2 and 3). She was treated conservatively with continuous halter traction using 4-lb weight. The neck pain and torticollis resolved within 4 days. She was discharged home with a Philadelphia collar for 6 weeks. On follow-up 3 months later the patient was free from pain and torticollis and had resumed normal activity. 1.2. Case 2

Supracondylar fracture of the humerus with ipsilateral fracture of the scaphoid in a child.

An 1 1 year old boy fell off a swing onto an outstretched left hand. He attended the accident and emergency department with a painful, swollen left elbow. Radiography of...

Recovery following fractures of the clavicle treated conservatively

A consecutive series of 140 patients with fractures of the clavicle were reviewed a minimum of 3 months after their injury. All had been treated conservatively using either a figure-of-eight bandage or broad arm sling. No statistical difference was found in the speed of recovery P > 0.05 when these two methods of treatment were compared in patients matched for sex and age. The patient's age at the time of the injury, however, did affect recovery with 33 per cent of those over the age of 20 years still having symptoms 3 months after they had sustained their fracture. Although lateral third fractures occurred more commonly in this age group than in the younger patients, the site of fracture did not adversely affect the speed of recovery P > 0.05.