We present a distinctly rare case of giant cell arteritis involving the small artery of the median nerve with symptoms that may be confused with carpal tunnel syndrome. The excision of the involved arterial segment cures the patient of the local symptoms, but the administration of corticosteroids as soon as the diagnosis is established is very important for these patients with multiple arterial involvement.
Twenty-two consecutive segmental tibial fractures were treated by Ender nails and early weight bearing. Sixteen fractures were closed and six open. All the fractures healed after an average time of 4 months. No infection was encountered. Slight malalignment of the distal metaphyseal segment occurred in 5 cases, but all of them had full knee and ankle function.
A prospective study of 141 patients with 143 tibial shaft fractures has been carried out; 102 fractures were closed and 41 open. All the patients were treated by Ender's nailing and early weight-bearing. The average healing time was 15.2 weeks. There were no cases of bone infection and complications were minimal, the commonest being slight malalignment. Using this method, rapid restoration of bone continuity was achieved, combined with almost normal limb function during treatment.
Our patient differs from most others described in that the symptoms and E.C.G. changes were readily reproduced on swallowing, without resort to balloon dilatation of the oesophagus.In addition his syncope was a presenting symptom of oesophageal carcinoma.Since an oesophageal lesion is commonly found in patients with "swallow syncope" we suggest that a barium swallow should be performed in all patients with this syndrome, even in the absence of dysphagia.We are grateful to Dr. R. W. Portal for permission to report on one of his patients and for his help with the preparation of the manuscript, and for the help of Mr. K. Moghissi who performed the operation.
AbstractThe results of 31 fractures of the tibial shaft treated with closed Ender nailing and early weight-bearing are reported. Twenty-five of these fractures were closed and six open. All fractures united between 6 and 16 weeks after operation. No case of deep wound infection was encountered. Comminuted fractures of the proximal and distal third were prone to angular deformities and needed cast protection post-operatively. Nail reinsertion became necessary in two patients. Delay of operation renders closed reduction very difficult.The advantages of this method are: 1) normal knee and ankle movements are possible during healing and 2) there is a relatively rapid restoration of bone continuity.Key words: fracturefixationtibia
