Acromioclavicular Dislocation

Death from Homologous Serum Jaundice following Nail-Arthrodesis of the Hip. Specimen of Right Hip-Joint shown.-W. D. COLTART, F.R.C.S. The Conservative Treatment of Lumbar Disc Lesions.-E. J. CRISP, M.B. The majority of lumbar disc lesions, with or without sciatica, generally recover completely if treated by adequate conservative measures. Bed rest, by itself, is insufficient. In hospital, the bed-making routine subjects the patient to considerable movement, while if treated at home he gets up for toilet purposes. The lumbar spasm which develops after a disc injury is protective, and holds the spine in the optimal position both for the patient's comfort and to allow healing to take place, and it is essential that movement at the site of the lesion should be minimal. By the application of a plaster jacket the natural processes of repair may be not only assisted, but accelerated. The plaster is applied with the patient standing in the position of greatest comfort, and it is important that no attempt should be made to correct deformity. Anteriorly the plaster extends from the xiphisternum to the pubis, posteriorly from the inferior angles of the scapule to the tip of the coccyx. The plaster is accurately moulded to the pelvis and the lower ribs, and is cut away at the groins to allow the patient to sit down. The plaster is light, comfortable and allows him to remain ambulatory. The patient rests in bed until the pain is relieved, usually a matter of a few days only, after which he is allowed to get up, and in due course to return to his usual occupation. It is essential that the plaster, or replaster, should be worn for upwards of three months to ensure sound healing. The object of the treatment is not only to bring about repair of the injured disc, but also to produce a fibrous ankylosis of the affected segment, and thus prevent further trauma. Adaptive shortening of ligaments and muscles at the site of the lesion restricts movement to a minimum, especially forward flexion. After removal of the plaster hyperextension exercises are given, but lumbar flexion is left to return spontaneously. A lumbar brace is worn for a further three months as a safety measure, and to give the patient confidence. Three cases of acute sciatica following rupture of an intervertebral disc were shown, wearing plaster jackets. All three patients, a blacksmith, a tailor's cutter and a clerk, derived such complete relief from this form of treatment that they were able to return to work within seven days of the application of the plaster.