Nel, M. L.

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21 Tovember 1959 S.A. MEDICAL JOURNAL 981Figs. 8A, 8B, 8e and 8D.teeth occlusion.manipulation under general anaesthesia is carried out byloosening and re-tightening the clamps.Occasionally a loose tooth in the fracture line, or oneinterfering with normal dental occlusion, needs extraction.The pins are removed in the clinic after 6 weeks, and thepatient discharged. There is firm fibrous union at this stage,although bony union does not occur for 12 months orlonger.Advantages of the Technique1. The period of hospitalization is only 6 or 7 days.2. The patient is able to enjoy a normal diet immediatelythe splint has been applied, because with this techniquethe fracture is immobilized without the mandible beingimmobilized (Figs. 8).3. The patient is able to return to manual labour withina few days; this aspect is particularly important in non-Europeans, who are frequent victims of this injury andcannot afford to be off duty for any length of time.ComplicationsThese are few, and consist of occasional subcutaneousinfection or osteitis. No case of osteomyelitis has occurred.In a few cases the pins have loosened in their tracks, butthis has occurred at a late stage and has not interfered withthe end-result. Such complications as may occur frominfection along the pin track are negligible compared withthe advantage that the patient is able to eat normally andreturn to his job within a week.DISCUSSIONIntermaxillary fixation in one form or another carries thefollowing drawbacks:Note wide-open mouth and good1. Inability to eat normally. Sometimes healthy teethhave to be sacrificed to allow of tube feeding.2. Inability to hawk or expectorate, with consequentdamming back of bronchial secretions and chest discomfort.3. Excessive loss of weight due to inadequate diet.4. Inability to perform heavy manual duties because ofpoor diet and inanition.5. There is some difficulty in removing the wire fixation.6. Should the patient require emergency surgery whilstthe mandible is -immobilized, the anaesthetic would presentserious difficulties.The criticisms that are levelled at the technique of ex-ternal pin fixation in standard text-books on maxillo-facialinjuries are (1) That the degree of immobilization of thefragments .achieved is inadequate to guard against l·nal-union, and (2) that the fixation is not sufficiently accurateto ensure perfect occlusion, and that even a very minordegree of residual malocclusion reflects improper treatmentand will lead to dental caries.As our practice is predominantly non-European andlong-term follow~up is impracticable, we are not able tosettle the question of delayed dental caries developing inthese cases. We do feel however that the advantages of shorthospitalization with early return to work and immediateresumption of full diet weigh heavily in favour of the adop-tion of this technique, particularly for the non-Europeanpatient.We wish to thank Dr. J. D. Prestwich, Superintendent, EdenvaleHospital, for his permission to publish this paper.'N ONGEWONE KOMPLIKASIE VAN 'N FRAKTUUR VAN DIE FEMURSKAGM. L. TEL, M.B., CH.B., Ortopediese Afdeling, Algemene Hospitaal, PretoriaOp 24 Oktober 1958 is 'n 30-jarige Naturellernan tot dieAlgemene Hospitaal, Pretoria, toegelaat met 'n fraktuur vansy linker-femur.Die fraktuur was reeds presies 2 maande oud en is tot opdaardie tydstip behandel in 'n Thomas-spalk met vel-trekking.Die geskiedenis was dat hy gegly en geval het op 26 Augustus1958. Hy is na 'n naburige hospitaal geneem en rontgenfotoshet 'n fraktuur getoon van die boonste derde van die skagvan die linker-femur.By toelating is weer rontgenfotos geneem. Die fragmentehet nog 'n groot mate van verplasing getoon (Arbs. 1 en 2)met oorvleueling en verkorting. ' Oormatige kallus was982 S.A. TYDSKRIF VIR GENEESKUNDE 21 November 1959teenwoordig. Dit het egter rue na normale kallus gelyk rue,en groot sistiese holtes is daarin opgemerk.Die pasient het nog gekla van pyn en daar was kliruesreeds hegting. 'n Verspreide geswel was teenwoordig metrooiheid en warmte van die oorliggende vel. Die geswel wasrubberhard en drukteer. Daar is nie opgelet na geruise oftrilling me. Die sirkulasie in die ledemate was goed.Daar is besluit om 'n oop reduksie van die fraktuur te doonmet intramedullere fiksasie. Die snit -is gemaak langs dieanterolaterale kant van die dy. 'n Rubberharde massakallus wat op plekke met die vinger ingedruk kon word, isontbloot tussen die fragmente. Nadat die kallus versigtigmet 'n osteotoom probeer verwyder is, is 'n groot gelokuleerdeholte revind, so groot soos 'n man se vuis. Dit het gladdeglansende wande gehad, oordek met ongestolde bloed. Indie holte was 'n groot hooveelheid swart ongestolde blood.Nadat dit uitgesuig was, is gevind dat die hoIte weer stadigopvul met donkerkleurige bloed. Met verdere disseksie isAfbs. 1 en 2. Verplasing van die skag van die femur met oor-matige kallus en sistiese holtes daaringevind dat die arteria profunda, sowel as die vena in dieagterste wand van die kallus betrokke was en gedurende diedisseksie is die vate geskeur en moes afgebind word. Hiernais die fraktuur gereduseer en met 'n Kiintscher-tipe pengefikseer. Heelwat meer as die gemiddelde hoeveelheidblooding het tydens die operasie plaasgevind en 2 pinteblood is toegedien.Na die operasie is die klopping in linker-been met 'n matevan omus gereeld dopgehou. Die dorsalis pedis het steedsswak kloppinge getoon, maar binne 2 uur was al die poisein die been sterk waarneembaar en geen tekens van ver-steurde sirkuIasie meer waarneembaar rue. Die res van diepostoperatiewe verloop was normaal.In retrospek kan die eienaardige voorkoIDS van die rontgen-foto nou soos volg verklaar word: dit het die tipiese.voorkomsvan 'n aneurismale beensis.Blykbaar was daar geringe beskadiging van die bloodvatein die gebied van die fraktuur, nI. die arteria en vena profundafemoris, waar 'n kommunikasie bestaan het tussen die frak-tuur-hematoom en die genoemde vate. Met die ontstaanvan nuwe been is die hematoom omsluit met baIkies en asgevolg van die arteriele kloppinge in die hematoom is uit-setting van die nuwe been veroorsaak, tesame met die soge-naamde seepbel voorkoIDS. As daar voor die operasieversigtiger te werk gegaan was, sou 'n geruis sekerlik hoor-baar gewees het wat 'n mens op jou hoode sou kon stel virdie moontlikheid van 'n vaskulere komplikasie. Nogmaalsis die ou bekende feit weer beklemtoon: oop reduksies vanhierdie frakture behoort me aangepak te word sonder vol-doonde chirurgiese fasiliteite nie, selfs wanneer arterielehegtings of oorplantings gedoen moet word. Genoogsamebloed vir oortapping rooet ook binne vinnige bereik wees.OPSOMMING'n Geval is beskryf waar 'n aneurismale beensis 'n fraktuurvan die boonste derde van die femur kompliseer. Die belangvan voldoende chirurgiese fasiliteite en bloed vir oortappingby die hantering van hierdie gevalle word beklemtoon.SUMMARYAn unusual complication of fracture .of the femoral shaft isdescribed. Pre-operative X-rays of a 2-month-old fractureshowed cystic spaces in the callus. During operation forinsertion of an intramedullary pin, a cystic space filled withblood was exposed in the callus between the bone fragments.The profunda femoris artery and vein were ligated as thesevessels communicated with t1I.e cyst. The patient made anuneventful recovery.The importance of having adequate facilities to deal withvascular complications during open reduction of this typeof fracture, is stressed.Graag wil ek teenoor dr. J. G. du Toit, Hoof van die Ortope-diese Afdeling, en dr. I. S. de Wet, ortopediese chirurg, mydank betuig vir hulle hulp en aanmoediging. Ook wiI ek dr.J. T. Vorster, Superintendent, Algemene Hospitaal, Pretoria,bedank vir sy toestemming om die geval te publiseer.FORTHCOMING INTERNATIONAL MEDICAL CONFERENCESThe Thirteenth Annual Meeting of the World Federation forMental Health will be held in Edinburgh from 7 to 12 August1960 at the kind invitation of the Scottish Association forMental Health. The general theme will be 'Action for mentalhealth'. Further information will be sent, as it becomesavailable, to all member-associations, affiliated organizationsand associates. Enquiries should be addressed to theSecretary-General, World Federation' for Mental Health,19 Manchester Street, London, W.I.

'n Ongewone komplikasie van 'n fraktuur van die femurskag

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'n Ongewone komplikasie van 'n fraktuur van die femurskag

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