Acta Orthop Belg
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We investigated the safety of LIA (local infiltration analgesia) combined with retransfusion of drained blood. Total knee arthroplasty patients received two peri-articular injections during surgery followed by continuous infusion, both with ropivacaine (567 mg). Ropivacaine plasma concentrations were determined in blood samples taken at 0, 3, 6 and 24 hours postoperatively. ⋯ The estimated cumulative ropivacaine plasma levels showed that instant retransfusion would have led to plasma levels below 0.26 mg/L. It appears to be safe to transfuse autologous blood in combination with LIA. However, before drawing definite conclusions formal measurement of actual concentrations is required.
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The functional outcome of hemiarthroplasty in displaced proximal humeral 3- and 4-part fractures or fracture dislocations in elderly patients is frequently unpredictable and depends on the position of the prosthesis and tuberosity fixation. Reverse shoulder arthroplasty represents an alternative in elderly patients. The purpose of this study was to report the results of a retrospective series of 30 reverse shoulder prostheses in trauma indications. ⋯ Radiographs revealed no loosening, no glenoid notching. Reverse shoulder prosthesis may be a good alternative for displaced three- and four-part proximal humeral fractures in selected patients. The functional results are more predictable than with hemiarthroplasty in elderly patients.
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Percutaneous vertebroplasty (VP) and balloon kyphoplasty (BKP) are minimally invasive procedures performed to stabilize vertebral fractures. With continuing expansion in clinical use, a broad spectrum of complications has been reported for both interventions. The goal of the current study was to compare the safety of these procedures using a questionnaire completed by practitioners. ⋯ Overall, BKP appears safer than VP. Symptomatic complications are rare with both procedures. Additional prospective data is necessary to reach more definitive conclusions.
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Percutaneous iliosacral screw placement is a standard stabilisation technique for pelvic fractures. It is a demanding operative technique. Various methods of guidance are currently available. ⋯ From January 2008 to December 2009, 27 screws were inserted using this technique in 21 patients with a pelvic fracture. The rate of incorrect placement was 11%. This technique does not require highly specialised equipment and is precise in determining both the entry point and drill track.