Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 1999
Randomized Controlled Trial Comparative Study Clinical TrialPain therapy following joint replacement.A randomized study of patient-controlled analgesia versus conventional pain therapy.
A prospective randomized trial in 42 patients undergoing elective total hip or knee arthroplasty under general anaesthesia was carried out to evaluate the efficacy of patient-controlled analgesia (PCA) versus demanded conventional pain therapy (CPT) for controlling postoperative pain. Four patients had to be excluded from the study (2 postoperative confusion, 1 elevated piritramid dosage caused by chronic pain therapy, 1 stressed by PCA pump handling). PCA group (n = 19) received piritramid via PCA pump, CPT group (n = 19) received tramadol (oral or intramuscularly) or piritramid intravenously. ⋯ The PCA group required on average twice as much piritramid-equivalent than the CPT group (P < 0.001). Patient satisfaction was good in both groups, but significantly better in the PCA group (P < 0.01), although the measured postoperative individual pain scores were above the preoperatively determined individual subjective pain threshold in the majority of both groups. From these results we draw the conclusion that even if the patients feel satisfied by the pain therapy administered, the majority are objectively treated below their individual subjective pain threshold.
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Arch Orthop Trauma Surg · Jan 1999
ReviewPrevalence of popliteal cysts in children. A sonographic study and review of the literature.
Popliteal cysts in children differ from those in adults. They are considered to be less frequent and usually appear in the absence of intra-articular lesions. However, their prevalence in asymptomatic children is unknown. ⋯ A popliteal cyst could be identified in 4 patients. The prevalence of asymptomatic popliteal cysts was thus 2.4%. For 2 of these patients, we obtained magnetic resonance image of the knee which showed no concommitant intra-articular pathology.
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Arch Orthop Trauma Surg · Jan 1999
Randomized Controlled Trial Clinical TrialDeep vein thrombosis in elderly Hong Kong Chinese with hip fractures detected with compression ultrasound and Doppler imaging: incidence and effect of low molecular weight heparin.
Seventy-eight patients of average age 78 years suffering from an unilateral non-pathological hip fracture underwent compression ultrasound and pulsed and colour Doppler examination of both legs. Twenty-three patients were randomly placed on low molecular weight heparin (LMWH). Twenty-nine (37%) suffered deep venous thrombosis (DVT). ⋯ There was no statistically significant difference in overall incidence of DVT between patients on prophylactic heparin and the control group. Patients on prophylactic heparin had no thigh DVTs in comparison to the control group. LMWH may thus be effective in preventing thigh DVTs and pulmonary emboli.
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Arch Orthop Trauma Surg · Jan 1999
Clinical Trial Controlled Clinical TrialImmunohistochemical localization of collagen VI in arthrofibrosis.
Arthrofibrosis is a disabling complication after knee trauma and surgery. Clinically, it is characterized by pain and joint stiffness due to massive connective tissue proliferation. In similar pathological conditions with fibrotic transformation such as lung fibrosis or superficial fibromatoses, an increased expression of collagen type VI has been reported. ⋯ Histologic analysis showed a synovial hyperplasia with inflammatory cell infiltration and vascular proliferation. Compared with normal synovial tissue, type VI collagen was widely distributed as a network subsynovially and around the capillary walls. The results of the present study suggest that dysregulation of collagen VI synthesis could be an important contributing factor in the complex mechanisms of disordered matrix protein deposition leading to arthrofibrosis.
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Arch Orthop Trauma Surg · Jan 1999
Clinical Trial Controlled Clinical TrialThe classic nail in the therapy of trochanteric fractures.A prospective, controlled study.
In a prospective controlled study we analysed the classic nail, a new intramedullary implant for the fixation of peritrochanteric fractures. By means of lateral bending of 4 degrees, unreamed implantation is generally possible. Our collective of 85 patients was characterized by elderly mean age (82.3 years), a predominance of female patients (4.3 : 1), a minor trauma aetiology without relevant additional injuries, and a high rate of concomitant disease (92%). ⋯ The mortality (30 days: 18%, 6 months: 25%) as well as the high rate of unspecific complications (20%) were caused by the patients' multiple morbidity. Deficits in the Merle d'Aubigne score at follow-up after 6 months can be interpreted within the same context. Nevertheless, 85% could return to their former social environment and only 15% became dependent on a nursing institution in connection with the fracture treatment.