title: Case report: managing fractures in non-compliant alcoholic patients--a challenging task.
abstract: OBJECTIVE
  To investigate whether there are extractable conclusions for limb fracture management in dependent alcoholics.
  
  
  METHODS
  We discuss four cases of dependent alcoholics who presented in our department over a 12-month period, and who developed significant complications owing to non-compliance with treatment.
  
  
  RESULTS
  Initial treatment, although appropriate, failed because of non-compliance. This led to further admissions, wound infections and surgery to enable cure.
  
  
  CONCLUSIONS
  Our case reports indicate that for upper limb fractures of the middle third of the humerus, non-operative treatment or internal fixation with out-patient detoxification is appropriate. Lower limb fractures, on the other hand, should be dealt with by external fixation and in-patient detoxification. It is imperative that the alcohol dependence is addressed if we are to decrease non-compliance.
authors.affiliation: Department of Trauma and Orthopaedics, Manchester Royal Infirmary, Manchester, UK.
authors.forename: C P
authors.initials: CP
authors.lastname: Charalambous
authors.forename: C S
authors.initials: CS
authors.lastname: Zipitis
authors.forename: R
authors.initials: R
authors.lastname: Kumar
authors.forename: P
authors.initials: P
authors.lastname: Hirst
authors.forename: A S
authors.initials: AS
authors.lastname: Paul
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000150:complications / Q000523:psychology* / Q000628:therapy*; D016512:Ankle Injuries / Q000209:etiology / Q000523:psychology / Q000628:therapy; D019468:Disease Management; D050723:Fractures, Bone / Q000209:etiology* / Q000523:psychology / Q000628:therapy*; D006801:Humans; D006810:Humeral Fractures / Q000209:etiology / Q000523:psychology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016312:Treatment Refusal / Q000523:psychology*