Injury, Int. J. Care Injured 34 (2003) 799–807

Correspondence

Letter to the EditorThe unforgettable finger tourniquet

We read with interest the article by Tucker and Harris[1] on a novel strategy to minimise the risk of iatrogenicdigit ischaemia through the use of an “unforgettable fingertourniquet”. The authors propose the use of a coloured glove(the Derma PreneTM glove, Ansell Medical), this equipmentis however not uniformly available.

An alternative is to take the red cord commonly usedto bind batches of surgical swabs together. This can bepassed below any finger tourniquet using a curved haemo-stat and then clipped to form a loop. The cord can thenbe used to temporarily lift the tourniquet to facilitate accu-rate haemostasis at the end of the procedure. If a haemo-stat is clipped to the cord it is difficult to forget, and asan extra-precaution it is included in the surgical assistantsequipment count.

Reference

[1] Tucker S, Harris PC. The unforgettable finger tourniquet. Injury2002;33(1):76–7.

Ian GrantAddenbrookes Hospital, Hills Road

CB1 2QQ Cambridge, UKTel.: +44-1223-245-151; fax:+44-1223-257-177

E-mail address:ian.grant@ntlworld.com (I. Grant)

Accepted 18 July 2002doi:10.1016/S0020-1383(02)00267-X

Letter to the EditorThe Mennen femoral plate for fixation of peripros-thetic femoral fractures following hip arthroplasty[Injury 33 (2002) 47–50]

I read with interest the article by Ahuja and Chatterji [1]and I agree with their conclusion that the Mennen plates areunsuitable for most of the periprosthetic femoral fractures.However, I would like to raise the following points.

Firstly the Johansson classification system [2] states thatthe type II fractures are those in which the fracture lineextents from the proximal portion of the femoral shaft to be-yond the distal tip of the prosthesis, with the prosthetic stemdislodged from the medullary canal of the distal fragment.

According to Johansson et al. [2], type II fractures have un-stable stems and should therefore be treated surgically withrevision to a long stem prosthesis and other additional meth-ods of internal fixation, including bone grafting in cases ofcomminution. The authors state that none of the patientshad evidence of radiological loosening of the prosthesis,despite 10 out of the 16 fractures were classified as type II,I therefore presume that the Johansson’s classification waseither misinterpreted or the stability of the prostheses wasoverlooked.

Secondly in the treatment of type III, are those in wherethe fracture is entirely distal to the tip of the prosthesis, Jo-hansson et al. [2] suggest conventional plate fixation. Thearticle by Ahuja and Chatterji [1] presents five type III frac-tures treated with Mennen plates, but the outcome of thistreatment is not clearly stated.

In conclusion, the importance of prosthesis stabilityshould not be underestimated. Careful evaluation of theprosthesis stability and revision to a long stem prosthesis(bypassing the most distal fracture line by at least twofemoral diameters) when the original stem is unstableshould therefore be considered [3].

References

[1] Ahuja S, Chatterji S. The Mennen plate for fixation of periprostheticfemoral fractures following hip arthroplasty. Injury 2002;33:47–50.

[2] Johansson JE, McBroom R, Barrington TW, Hunter GA. Fracture ofipsilateral femur in patients of total hip arthroplasty. J Bone JointSurg 1981;63A:1435–42.

[3] Garbuz DS, Masri BA, Duncan CP. Periprosthetic fractures of thefemur: principles of prevention and management. Instr Course Lect1998;47:237–42.

Eleftherios TsiridisDepartment of Trauma and OrthopaedicsThe Whittington Hospital, Highgate Hill

London N19 5NF, UKPresent address: 41 Chelsea Towers, Chelsea Manor

Gardens, SW3 5PN, London, UKTel.: +44-20-7351-2706; fax:+44-20-7351-2706

E-mail address:etsiridis@hotmail.com(E. Tsiridis)

Received 4 September 2002doi:10.1016/S0020-1383(02)00394-7

© 2003 Published by Elsevier Ltd.