CONGENITAL POSTURAL DEFORMITY OF THE WRIST

Partridge (1976) designed his cerclage system in an attempt to avoid the interruption ofcortical blood flow known to be produced by other methods of cerciage (Parham and Martin 1913 4). The Partridge band has a series of projections on its inner surface and these are thought to protect the cortical circulation. The entire system consists of self-locking straps and simple instnumenta t i 0 n. This method offracture fixation has been used regularly in our department for the treatment of spiral and comminuted femoral shaft fractures. Three cases with serious orthopaedic complications related to the use of these hands are reported. Case I. A 21-year-old girl involved in a road traffic accident in 1982 suffered a comminuted fracture ofthe midshaft of the right femur. This was treated by early K#{252}ntscher nail fIxation; for added stability a single Partridge hand was placed around a butterfly fragment. Her initial progress was uneventful and the fracture was thought clinically to have united some 22 weeks later. She was reviewed two years after her injury when she still complained of pain at the fracture site. The K-nail was removed, hut unfortunately the fracture was still mobile. Radiographs (Figs 1 and 2) showed loss of bone under the hand and non-union. This non-union was treated by further K-nail fixation, removal of the Partridge hand and iliac crest bone-grafting. At operation the loss of cortical hone under the band was confirmed. Case 2. A 23-year-old man was knocked over by a car and sustained a comminuted fracture at the junction of the middle and lower thirds of his left femur. He was treated hy early K-nail fIxation with two Partridge bands to secure a butterfly fragment. He was mobilised early in a cast-brace fully weight-hearing, hut a year later he still complained of pain on stressing the fracture. Radiographs taken at this time showed obvious loss of cortical bone under the hands and an avascular butterfly frag-