Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Mar 2000
Case ReportsIatrogenic ulnar nerve injury after percutaneous cross-pinning of supracondylar fracture in a child.
Supracondylar fracture of the humerus is the most common fracture of the elbow in children and has been treated by a variety of methods. Recently, stabilization of reduced fractures with percutaneous pin fixation has become the accepted method of treatment. Ulnar nerve injury is a complication of percutaneous pinning of supracondylar fractures, although many authors have reported that it resolves spontaneously after removal of the pin.
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J Shoulder Elbow Surg · Mar 2000
Clinical Trial Controlled Clinical TrialPatient-controlled lidocaine analgesia for acromioplasty surgery.
Twenty-four consecutive patients undergoing shoulder acromioplasty were given postoperative analgesia with a new method in which a patient-controlled continuous infusion of lidocaine infiltrated the subacromial space. Seventeen of the acromioplasties were done with arthroscopy, whereas 7 were performed with an open procedure. A 2% solution of lidocaine without epinephrine was used for both a continuous dose of 2 cc/h and patient-controlled interval doses of 1 cc administered at 15-minute intervals. ⋯ Blood levels of lidocaine averaged 0.3 microgram/mL in the 12 patients studied. Subjective pain levels and the amount of supplementary pain medication used were both lower in the group receiving patient-controlled lidocaine analgesia at statistically significant levels (P = .168 measuring subjective pain level, and P = .0212 measuring supplementary pain medication use). Patient-controlled lidocaine analgesia in the subacromial space appears to be a safe method for achieving high levels of pain control in patients undergoing an acromioplasty.
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The glenoid articular surface is best studied radiographically on a tangential projection with both true anteroposterior and axillary views. Forty-one dry scapulas were studied under fluoroscopy to define the axillary projection that would provide a true scapular lateral view. The superior and inferior articular margins were marked with radiopaque solder wires. ⋯ X-ray films taken of another 8 cadaver shoulders were used to study the position of screws inserted about the glenoid articular surface. The soft tissue shadow superimposition on the inferior glenoid margin can lead to a misinterpretation of the superior margin as the whole glenoid articular surface. Because soft tissue can interfere with the appreciation of the glenohumeral joint line on an axillary view, a projection that will show a continuous line of the coracoid and glenoid articular surface should be obtained, and it will indicate a tangential view of the joint.