Acta Orthop Belg
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Case Reports
Can peripheral nerve blocks contribute to heel ulcers following total knee replacement?
Peripheral nerve blocks are widely used for postoperative analgesia following total knee replacement. We would like to present three cases of heel ulcers encountered following a peripheral nerve block for knee replacement surgery. ⋯ Attention needs to be given to the pressure points in the foot after the nerve blocks. Awareness of this uncommon complication is necessary to prevent its occurrence.
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Comparative Study
Suction dressings in total knee arthroplasty--an alternative to deep suction drainage.
A new technique is described for dressing of surgical wounds in total knee arthroplasty that is a combination of a semi-permeable dressing and suction drainage. This technique has been used in 100 consecutive cases and drainage was collected in 92. ⋯ Haematoma formation causing moderate soft tissue tension and some patient discomfort was noted in 9 knees. This form of postoperative wound management retains the nursing and hygiene advantages of deep suction drainage, whilst avoiding the patient discomfort and potential complication possibilities associated with deep internal drainage.
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Comparative Study
Results of surgical treatment for kyphotic deformity of the spine secondary to trauma or Scheuermann's disease.
The authors have performed a retrospective study of 20 patients who underwent surgical treatment for kyphosis secondary to trauma (10 patients) or Scheuermann's disease (10 patients) between 1992 and 2000. The mean follow-up was 60 months (range, 32-90) and 59.5 months (range, 24-109) respectively. Radiological evaluation of Scheuermann kyphosis included assessment of thoracic kyphosis angle (TKA), lumbar lordosis angle (LLA), scoliosis angle (SA) and sagittal vertical axis (SVA); radiological evaluation of post-traumatic kyphosis included the determination of local kyphosis angle (LKA) and SA, if present. ⋯ At the last visit, the mean loss of correction was 2 degrees. Proximal junctional kyphosis developed in two cases with Scheuermann kyphosis (17 degrees and 13 degrees) and in one case with post-traumatic kyphosis (17 degrees). These findings show that good results can be achieved in the treatment of kyphosis secondary to trauma or Scheurmann's disease, with appropriate selection of the surgical approach.
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Comparative Study
Systemic effects of bilateral tibial versus bilateral femoral shaft fractures. Is there a difference?
The authors investigated the prevalence and the difference in the severity of systemic complications following intramedullary nailing of bilateral tibial and femoral shaft fractures. A retrospective chart analysis of 12 consecutive patients with bilateral tibial shaft fractures (TF) and 14 patients with bilateral femoral shaft fractures (FF) was performed. The incidences of bilateral tibial fractures and bilateral femoral shaft fractures were 3.8% and 4.6% respectively. ⋯ In the FF group, there were 6 cases of ARDS (p = 0.04), 1 case of deep sepsis and 1 above knee amputation. Patients with bilateral tibial shaft fractures revealed lower ISS, resuscitation requirements, ARDS, associated injuries, and mortality when compared to bilateral femoral shaft fractures. This is probably due to the anatomical difference in the morphology of the bones, volume of liberated intravascular marrow fat, organisation and layout of the venous capillary network and severity of associated injuries.
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The authors report a case of cardiac arrest following interscalene brachial plexus block in the sitting position for shoulder arthroscopy. The cardiac arrest occurred 45 minutes after interscalene brachial plexus block. It seems that it resulted from the activation of Bezold-Jarisch's reflex and a related vasovagal syncope.