International orthopaedics
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Circular external fixation using the Ilizarov apparatus combined with compression-distraction techniques was used to treat 11 patients with infected non-union and segmental bone loss of the tibia. The series comprised 8 males and 3 females, with an average age of 27 years (range 17-51 years). ⋯ The functional results were excellent in 5, good in 3, fair in 2 and poor in one patient. No additional procedures were used in any of the patients.
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Patients who were treated for fractures of the limbs were assigned to 1 of 2 groups for the management of postoperative pain. In Group 1 (postoperative patient-controlled analgesia group), 46 patients were given postoperative continuous epidural anaesthesia in combination with narcotic analgesics and this was regulated by the patient using a device. ⋯ The time spent by nurses for pain management in Group 1 was less than that in Group 2. It appears that this patient-controlled method, combined with postoperative continuous epidural anaesthesia, is a safe, effective and efficient method for the management of postoperative pain.
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A case of lateral disc herniation in the lumbar spine which occurred soon after percutaneous discectomy is described. This is a rare complication, but in this patient it appeared that the extrusion occurred through the hole in the annulus made at the first operation.
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Plaster of Paris implants containing vancomycin (60 mg/g of carrier) were prepared in order to be used as local delivery system for the treatment of bone infections. The regulation of the release rate was performed by coating the carrier with a polylactide-co-glycolide polymer composed by 10% (w/w) polyglycolic acid and 90% (w/w) racemic poly (D,L-lactic acid). The release of the antibiotic from the biodegradable matrix was evaluated in vitro. ⋯ It was shown that the in vivo release was also closely regulated by the coating depth. In all bone tissues (bone marrow and cortical bone) surrounding the pellets, the drug concentration exceeded the Minimum Inhibitory Concentration for the common causative organisms of bone infections (Staphylococcus aureus) for at least four weeks without inducing serum toxic levels. Due to its cheapness, facility of use and sterilization, biocompatibility and biodegradability, plaster of Paris coated with PLA45GA10 polymer giving a controlled release of vancomycin appears to be a promising sustained release delivery system of antibiotics for the treatment of bone and joint infections.
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One hundred adolescents undergoing posterior spinal fusion for scoliosis were reviewed to assess the adequacy of postoperative patient-controlled analgesia. There were 94 females and 6 males. The mean settings for morphine dosage were a loading dose of 114.5 micrograms.kg-1, a bolus dose of 24.8 micrograms.kg-1, and a lockout interval of 9.9 minutes. ⋯ Nausea and vomiting occurred in 45% and pruritus in 15%. There were 7 cases of respiratory depression who all recovered promptly and completely. This method is associated with high morphine requirements in adolescents, but can be used safely.