Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Nov 1995
Clinical TrialUnwashed wound drainage blood. What are we giving our patients?
Wound drainage blood was collected after total joint arthroplasty was completed in 13 consecutive patients. Peripheral blood samples were collected in the recovery room and at 6 hours postoperatively for all 13 patients. A standard enzyme-linked immunosorbency assay was done to quantify tumor necrosis factor-alpha, interleukin-1 alpha, interleukin-6, and interleukin-8 levels in the samples. ⋯ A comprehensive review of the literature revealed that unwashed drainage blood is a relatively dilute blood product lacking normal clotting factors and having numerous other undesirable components that may mitigate against its routine use in lieu of predeposited autologous or homologous blood. This is of interest because there is evidence indicating that wound drainage blood reinfusion may be unnecessary in total joint arthroplasty when autologous blood is available. Use of drains in this surgery also may be unnecessary and has been shown to increase the amount of blood loss and the need for transfusion.
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Clin. Orthop. Relat. Res. · Nov 1995
Injury to infrapatellar branch of saphenous nerve in arthroscopic knee surgery.
Injury to the infrapatellar branch of the saphenous nerve has been reported as a complication of arthroscopic examination and surgery of the knee. The authors studied the anatomic distribution of this branch in cadavers, and investigated the incidence of this complication in 68 patients. The results of anatomic study showed that blind puncture is safe within an approximate 30-mm area from the medial margin of the patella at the level of midpatella, and within an approximate 10-mm area from the medial margin of the patellar ligament at the level of the distal pole of the patella. ⋯ Anatomic findings indicated that blind puncture to the knee in a 90 degrees flexion position should be done horizontally and parallel to the articular surface to reduce the incidence of nerve injury. The results of this study of patients who had arthroscopy from 1990 to 1991 revealed a 22.2% incidence rate of sensory disturbances in the area where the infrapatellar branch is distributed. The incidence can be minimized by clarifying the distribution of the infrapatellar nerve branch in relation to palpable landmarks.
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Twenty-four cadaveric arms were dissected to determine the position of the radial nerve on the posterior aspect of the humerus relative to the posterior tip of the acromion, the medial and lateral epicondyles, the division between the lateral and long heads of the triceps, and the triceps aponeurosis. The radial nerve passed anterior to the long head of triceps and cross onto the posterior shaft of the humerus an average of 124 mm below the posterior tip of the acromion. ⋯ It was never within 100 mm of either epicondyle. The surgeon can use these landmarks as guidelines to avoid the radial nerve during operative intervention on the humerus.