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Twenty mid-clavicular fractures are reported which required plate fixation. This technique gave relief from pain within 12 hours and resulted in bony union in every case. The indications for this operation are described.

The significance of cobalt as a cause of symptoms after McKee hip arthroplasty is discussed. Seven patients are described in whom such arthroplasties. became unsatisfactory after periods varying from nine months to four years. Six of these patients were cobalt-positive but nickel- and chrome-negative on patch testing. Macroscopic and histological necrosis of bone, muscle and joint capsule around the prostheses was found in five patients whose hips were explored. The symptoms were progressive pain, a feeling of instability, and in two cases spontaneous dislocation. Radiological features included acetabular fracture, bone resorption, loosening and dislocation of the prosthesis. Increased cobalt concentrations (determined by atomic absorption spectrophotometry) in the urine of four patients and in a variety of tissues in one patient are presented. Patch testing is recommended in the investigation of patients with troublesome McKee hip arthroplasties

An open transverse fracture of the mid-shaft of the tibia of a professional footballer became infected by Clostridium septicum and, after early compression plating, required surgical intervention on three further occasions and extensive antibiotic treatment before healing occurred. Clostridial infection is a recognized complication of open fractures contaminated with soil, and the necrotizing toxins produced by the C. septicum were probably responsible for the persistence of this infection. Infection occurred in less than 1 per cent of our series of 215 operations of compression plating of fresh fractures of the tibial shaft. Infection by clostridium species is a serious complication of open fractures. This patient did not show the spreading inflammation and necrosis, or the marked systemic upset, characteristic of acute clostridial infection, but persistent local infection necessitated prolonged surgical and antibiotic treatment.