Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Feb 1994
Review Case ReportsMissed scapular fracture after trauma. A case report and a 23-year follow-up report.
Scapular fractures are important in that they are often associated with high morbidity and mortality. Frequently they are overlooked because of the severity of other associated injuries. Extraarticular scapular fractures are often treated conservatively, even when displaced. ⋯ This case report presents a missed scapular fracture and associated rib fractures with subsequent malunion and a 23-year follow-up assessment. Surgical resection of a distorted inferior medial border of the scapula and dorsal rib prominences relieved the patient's symptoms. The case presentation, diagnostic modalities, treatment, and possible long-term sequelae of this complex fracture are reviewed.
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Clin. Orthop. Relat. Res. · Feb 1994
Comparative StudyContinuous epidural analgesia using fentanyl and bupivacaine after total knee arthroplasty.
Eighty consecutive patients undergoing unilateral total knee arthroplasty received postoperative analgesia consisting of a continuous epidural infusion of fentanyl and bupivacaine. Nineteen patients (24%) were unable to complete the three-day course of epidural infusion: two thirds for technical reasons and one third because of adverse effects. The remaining 61 patients (76%) successfully completed the 72-hour protocol. ⋯ Nausea was problematic in both groups. The incidence of respiratory depression was 5% for either opiate. The degree of hypoventilation and treatment required for it were less severe with fentanyl, however.