Acta Orthop Belg
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The aim of this study was to evaluate the clinical effectiveness of distal forearm intravenous regional anaesthesia (IVRA) with the tourniquet applied 3 cm above the wrist. One hundred and twenty patients undergoing out-patient hand surgery were operated for 13 different hand problems under distal forearm IVRA, using 10 ml of a solution containing 1.5 mg/kg prilocaine. Sensory block onset time was 4.5 minutes (3.5-6.5 min.). ⋯ The mean VAS score for tourniquet pain was 3.8 (range, 2-10). No local or systemic side effects related to the IVRA were observed. The study showed that distal forearm IVRA using 10 ml of a solution containing 1.5 mg/kg prilocaine provides safe, rapid and effective anaesthesia for patients undergoing outpatient hand surgery.
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Ipsilateral fracture of the clavicle and scapula is considered to be a relatively rare injury. It is perceived as an unstable injury and is at times called floating shoulder. Understanding of the role played by the bony and ligament stability is important to identify true floating shoulder injury and to offer an appropriate treatment. ⋯ Recent literature has shown the important role played by the ligaments in providing stability in ipsilateral fracture of the clavicle and scapula. In a true floating shoulder injury, it seems important to stabilise the injury by fixation of the scapular fracture. This article reviews the literature to identify the injury pattern of true floating shoulder and to look at the current evidence for the treatment of such an injury.
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Comparative Study
Postoperative autologous blood salvage drains--are they useful in primary uncemented hip and knee arthroplasty? A prospective study of 186 cases.
There are nearly 43,000 hip replacements and 33,000 knee replacements performed each year in the United Kingdom. Many of these require a blood transfusion. However, there has been increased public concern about the safety of blood transfusion and various techniques are used to decrease the need for allogenic transfusion. ⋯ The mean transfusion costs were slightly less for re-infusion drain group (ł 182.70 per patient for re-infusion drain group and ł 196.75 per patient for suction drain group, p = 0.009). The hospital stay was also significantly reduced (11.0 days for re-infusion drain group as opposed to 12.6 days for suction drain group (p = 0.0248). Based on these findings, re-infusion drains appear as a cost effective means of reducing the requirement for allogenic blood transfusion following primary hip and knee arthroplasty.
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Comparative Study
Greater trochanter bursitis pain syndrome in females with chronic low back pain and sciatica.
Trochanteric bursitis is a clinical condition which simulates major hip diseases and low back pain, it may also mimic nerve root pressure syndrome. Patients with greater trochanteric bursitis pain syndrome (GTBPS) usually suffer from pain radiating to the posterolateral aspect of the thigh, paraesthesiae in the legs, and tenderness over the iliotibial tract.. The purpose of this study is to indicate the similarity between the clinical features of the GTBPS and those of chronic low back pain, and to highlight the importance of diagnosing GTBPS in patients complaining of low back conditions. ⋯ GTBPS is easy to diagnose and can be treated. Peritrochanteric infiltration with glucocorticoids mixed with 2% lidocaine relieves patients from their symptoms for a long period of time. Recurrence should always be expected, but treatment may be repeated.
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Comparative Study
The Long Gamma Nail for stabilisation of existing and impending pathological fractures of the femur: an analysis of 48 cases.
The results in a series of 42 patients with 48 impending or complete pathological femur fractures stabilised with the Long Gamma nail (Howmedica-Osteonics, Rutherford, NJ,USA) are presented. Twenty two impending and 26 completed pathological femoral fractures treated between 1995 and 1999 were retrospectively analysed. The mean age of the patients was 65.7 yrs (range: 40 to 88). ⋯ Implant failure occurred in one patient and needed revision to a long stemmed total hip prosthesis. The Long Gamma nail offers the advantage of a technically less demanding percutaneous insertion through the tip of the greater trochanter, secure proximal femoral fixation and the ability to allow immediate or early weight-bearing ambulation. Because of these advantages, we recommend the use of the Long Gamma nail for stabilisation of pathologic and impending pathologic fractures of the femur.