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Upgrading of a stretch of the A77, a major road in South West Scotland to Highway status has resulted in a significant reduction in the incidence of serious and fatal road traffic accidents on a major international route. Notwithstanding the pain and suffering prevented, the annual economic savings amount to over pound 6.1 Million ($12.14 M/euro 7.96 M) The Highway, with an effective central reservation barrier, will pay for itself in 17 years and will continue to prevent serious injury and save lives.

One year ago the British Orthopaedic Association issued guidelines for the prevention of cross-infection with special reference to HIV and the hepatitis viruses. We were interested to establish whether the guidelines were being widely applied and whether they had changed general orthopaedic practice. We distributed a questionnaire to Scottish Orthopaedic Fellows, Associates of the BOA, and orthopaedic trainees. With a 70 per cent return rate, it would appear that the recommendations are not adhered to in full. Of respondents, 84 per cent were immunized or undergoing immunization against hepatitis B. In all, 30 per cent were operating on high-risk patients on a monthly basis, 60 per cent thought that their current practice was low risk, and only 15 per cent thought that their future practice would be high risk; 81 per cent were concerned and yet only 60 per cent had altered their practice. It is of some concern that orthopaedic surgeons may not take the threat of HIV cross-infection seriously enough and do not consider precautions mandatory. Further pressure and support from the BOA may be necessary to encourage a change in orthopaedic practice as the threat of HIV is increasing.

A review of the results of arthroscopies on patients taken from an 'open access' service waiting list has been carried out. One-third of all arthroscopies proved to be negative. Accuracy of clinical diagnosis was not related to the clinical grade of the examining doctor. The excess annual cost to the Northern Ireland Orthopaedic Service of unnecessary arthroscopies may have been of the order of 89,000 pounds.

The incidence of a delay in the diagnosis of injuries from the 83 survivors of the M1 aircraft accident is described. A total of 32 injuries in 25 patients were not initially diagnosed, nine each in the upper and lower limbs and 14 in the spine. This was equivalent to 9.6 per cent of all the major injuries suffered by the survivors. Five patients required surgery for a late diagnosed injury. The incidence of a delayed diagnosis injury (DDI) was not related to the overall severity of injury. Delay in diagnosis of injuries after such a major accident was attributable to failure of clinical examination, failure to radiograph symptomatic areas and failure of radiographic interpretation.

The 79 survivors of the M1 aircrash have been assessed at an average of great britain 1 year after the accident. Return to work, continued hospital care and recovery from injuries has been found to be related to the severity of injury. The 188 pelvic and limb fractures have been reviewed and the incidence of complications from these injuries has been low. Spinal and lower limb injuries account for the majority of the residual disability.

There were 83 survivors of the M1 aircrash admitted to hospital; of these, 28 patients sustained a total of 40 open fractures. These open fractures were classified as 19 grade 3, 16 grade 2 and five grade 1. There were six upper limb fractures and 34 lower limb fractures. A high proportion of grade 3 open fractures were identified in this series (47 per cent) and one-half of these occurred at or below the ankle. This reflected the high energy and direction of the forces involved in the aircrash. The early results in terms of the incidence of wound infection (15 per cent), delayed wound healing (7.5 per cent) and skin flap necrosis (7.5 per cent) were similar to other series. The controversy over whether to leave grade 3 wounds open or closed was not clarified by this study, but the closure of grade 3 wounds after internal fixation is to be avoided. This study emphasizes the need for provision of adequate specialist manpower, equipment and resources to manage the unexpected major disaster successfully.

Two cases of isolated dislocation of the radial head in children are presented. The clinical presentation, radiographic appearances, management and prognosis are discussed, and a brief literature review is presented.