Journal of the Indian Medical Association
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Randomized Controlled Trial Comparative Study
A comparative study of paediatric oral premedication: midazolam, ketamine and low dose combination of midazolam and ketamine.
In a prospective randomised double-blind trial, 90 patients aged 1-7 years (ASA I) undergoing elective surgery less than 90 minutes duration were allocated into three separate groups to compare the safety and effectiveness of oral midazolam, ketamine, and low dose combination of midazolam and ketamine for premedication in paediatric patients. Group M received midazolam 0.5 mg kg(-1), group K received ketamine 6mg kg(-1) and group C received combination of ketamine 2.5 mg kg(-1) and midazolam 0.25 mg kg(-1) orally in 0.2ml kg(-1) of sugar syrup to make it palatable. The sedation score and emotional state on a four -point scale, ease of parental separation, cooperation for venepuncture, ease of mask acceptance and peri-operative cardiorespiratory status were evaluated. ⋯ Side-effects and recovery time were more in ketamine group. The recovery time was significantly less in group C. In conclusion oral combination of low dose ketamine and midazolam produced quick onset of satisfactory conscious sedation and more rapid recovery without significant side-effects, so that more children could be separated easily from their parents and provides smooth induction than the individual drug.
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Displaced midclavicular fractures resulting in malunion with shortening and rotational deformity does not remodel in adults and incidence of non-union in displaced midshaft clavicular fractures is between 10-15% especially in those with an initial shortening of >20 mm. We have treated 10 patients of displaced middle-third clavicle fracture by open reduction and internal fixation with plate and screws and found it to be very effective in respect to rehabilitation, union and cosmesis.
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Operative treatment modalities for calcaneal fracture are still controversial. The outcome of intra-articular calcaneal fracture is mainly influenced by the soft tissue and the subtalar joint. Percutaneous method of internal fixation has been attempted to avoid the problems. ⋯ Twenty-two patients with 26 calcaneal fractures were included. After a mean follow-up of 2 1/2 years and with American Orthopaedic Foot and Ankle Society hind foot score 82 points out of 100. Percutaneous fixation of calcaneum fracture is good alternative method in types IIA, IIB and IIC and selective type III fractures.
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Sixty-two femoral shaft fractures in 60 patients treated by elastic intramedullary nailing with mean age of the patients being 9.2 years (range 5 years to 12 years) and average follow-up of 15 months (range 7 months to 60 months) are evaluated. Twenty-eight fractures were fixed with titanium elastic nail while 34 fractures were fixed with Enders nail. There were 40 midshaft fractures, 18 proximal femoral and 4 were fractures of distal third. ⋯ The result demonstrates 100% union rate irrespective of the age, weight and height of the patient. Regardless of the site of fracture and their pattern, it united every time with elastic nail fixation. We did not find and mismatch in the results of fractures stabilised with titanium elastic nail with that of elastic stainless steel nail.
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Posterolateral corner injuries of the knee are usually associated with injuries to other structures of the knee. It is not unusual to miss this injury during the initial assessment. ⋯ Failure to recognise and reconstruct posterolateral corner injuries is one of the important reasons for the failure of cruciate ligament reconstruction surgery. In this article we have reviewed the literature regarding anatomy, biomechanics, clinical features and treatment of the posterolateral corner injuries of the knee.