J Bone Joint Surg Br
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J Bone Joint Surg Br · May 1991
Randomized Controlled Trial Comparative Study Clinical TrialPrevention of deep vein thrombosis after total hip replacement. The effect of low-molecular-weight heparin with spinal and general anaesthesia.
Enoxaparin, a low-molecular-weight heparin, has been used together with spinal or general anaesthesia in a prospective, randomised study of 188 consecutive elective hip replacements. Bilateral venography was performed on all patients on day 13 after operation. Group I (65 patients) received spinal anaesthesia and no immediate injection of enoxaparin. ⋯ Tolerance was good and the incidence of bleeding low in the three groups. Our results confirm the low rate of DVT in patients operated on under general anaesthesia with the standard procedure of 40 mg of enoxaparin on a once-daily basis started pre-operatively. The 40 mg-dose is also safe and effective in association with spinal anaesthesia if half the dose (20 mg) is injected an hour after the lumbar puncture.
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J Bone Joint Surg Br · May 1991
Comparative Study Clinical TrialChymopapain versus conventional surgery for lumbar disc herniation. 10-year results of treatment.
We reviewed two comparable groups of patients who had been treated for lumbar disc herniation by chymopapain chemonucleolysis (145) or conventional surgical discectomy (91). They were reviewed 10 years after treatment by questionnaire, followed by a personal interview by an independent observer. ⋯ In particular, there was significantly better early relief of leg and low back pain, and fewer patients needed a second procedure. Complications were few in both groups.
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J Bone Joint Surg Br · May 1991
Comparative StudyRefracture after the removal of plates from the forearm. An avoidable complication.
The incidence of refracture following the removal of screws and plates from the diaphyses of 115 forearm bones in 80 patients has been studied. Refracture occurred in four adult patients as a result of minimal trauma, in two patients at the original fracture site after premature plate removal, at the site of a countersunk interfragmentary screw in one and at the original fracture site in another who had required three operative procedures to achieve 'union'. It is suggested that refracture could have been avoided in at least two of these patients. If the 3.5 mm plating system has been used, the incidence of refracture should be minimal.
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J Bone Joint Surg Br · May 1991
Isolated rupture of the tendon of the subscapularis muscle. Clinical features in 16 cases.
Traumatic rupture of the tendon of the subscapularis muscle was documented as an isolated lesion in the shoulders of 16 men. The injury was caused either by forceful hyperextension or external rotation of the adducted arm. The patients complained of anterior shoulder pain and weakness of the arm when it was used above and below the shoulder level. ⋯ Confirmation of the clinical diagnosis was best achieved by ultrasonography or MRI, but arthrography or CT arthrography were also useful. Surgical exploration confirmed the diagnosis in every case. Repair of the ruptured tendon was technically demanding and required good exposure to identify and protect the axillary nerve.