Abstracts 85

department gives no reliable indication of the efftciency of its design, in which those working in the department may have had no say. The author describes both satisfactory and unsatisfactory features of departments visited but recognizes the need for different arrangements to cope with the different mixtures of cases in different hospitals. Among particular subjects dealt with are operating facilities (should they be major or minor or both?), layout and the provision of a central observation area, flow and segregation of cases, especially children, drunks and the chemically or zoologically contaminated, and the provision of a ‘weepers’ room’ with a free telephone.

Special Correspondent (1979) Accident and emer- gency services-design of departments. Br. Med. J. 2, 1204.

Tendons and ligaments

Treatment of ankle injuries This supplement begins with a description of the anatomy of the ligaments around the ankle joint, followed by a detailed review of the literature relating to the treatment of sprains of the ankle (fractures are specifically excluded).

The clinical signs of injuries to different parts of the lateral ligament are then described, including tilting of the talus in the ankle mortice (which may be due to rupture of the calcaneo-fibular ligament) and anterior movement of the foot on the leg, which the author describes as the ‘positive drawer sign’. The latter is associated with injury to the anterior talo-fibular ligament. He then points out that there are some fallacies in interpreting these clinical tests and suggests that the most reliable method of detecting ligamentous rupture is by means of arthrography. As a result of these radiographic studies, the author divides his series into three groups:

Group I, in which no ligamentous rupture is demonstrated.

and thecalcaneo-fibular ligaments are disrupted. He notes that there were some natients in all three

Group II, in which a rupture of the anterior talo- fibular ligament can be demonstrated.

Group III, in which both the anterior talo-fibular

chondro-osseous bodies originating from the articular surface of the talus.

Prins I. G. (1978) Treatment of ankle injuries. Acta Chir. Stand. Suppl486.

Shock

Pathophysiology of shock This article deals fairly briefly with shock resulting from injury, disease of the heart and sepsis, and may usefully be read in conjunction with three papers on shock that appeared in the March 1979 issue of this journal.

Ledingham I. McA. and Routh G. S. (1979) The pathophysiology of shock. Br. J. Hosp. Med. 22,472.

Central venous pressure measurement The method is based on measuring, by the Doppler method, the flow in the subclavian vein and recording the pressure exerted by expiration into a manometer that stops the flow.

Diirr J. A., Simon C. A., Vallotton M. B. et al. (1978) Non-invasive method for measuring central venous pressure. Lancet 1,586.

Miscellaneous

Requests for radiographs Five hundred casualty patients were studied to fmd out why radiographs were requested. Junior staff requested films in a higher proportion of cases than did consultants and less often found signs of fracture. Uncertainty after clinical examination was the main reason for this difference, but reassurance of the patient played a noticeable part, even with consult- ants, whereas medicolegal considerations prompted only about IO per cent of requests. While it is understandable, and duly cautious, of junior staff to tend to overuse radiography, they should be encour- aged to give continuing and careful consideration to their reasons for resorting to it.

Reasons for requesting radiographs in a casualty department. Br. Med. J. 1, 1595.

de Lacey G., Barker A., Wignall B. et al. (1979)

groups who were unable to bear wejght on the ankle. Having identified the anatomical lesion by arthro-

graphy, the treatment is then discussed in relation to the three groups previously described. The follow-up studies carried out 6 months later lead the author to the conclusion that groups I and II should be treated with an elastic stocking only (or occasionally in a walking plaster-of-Paris for 3 weeks), whereas group III patients should be submitted to operative repair, followed by 3 weeks in plaster-of-Paris. He suggests that some of the poor results of operation previously reported by other authors may have been due to a lack of understanding of the anatomical details and, there- fore, of the correct operative approach. In support of this policy, he notes that out of 69 ankles which were treated by operation, I5 showed interposition of a ligament between the joint surfaces and 2 had loose

Preventing ischial pressure sores The authors are a research offtcer and a ward sister who set out to devise a cushion that would distribute the patient’s weight evenly when seated. They found that thixotropes reduced maximum pressures below those recorded with conventional cushions. Their particular value lay in the fact that under load a gel becomes fluid and is distributed in accordance with the loads put upon it. The result was that pressure sores in persons who spent much of their time sitting in chairs showed healing of sores which had been present for up to I2 months.

Bowker P. and Davidson L. M. (1979) Development of a cushion to prevent ischial pressure sores. Br. Med. J. 2,958.