Orthopaedic review
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Extensor tenosynovitis is caused by a variety of conditions, but most commonly is associated with inflammatory arthritis. Extensor tenosynovitis with secondary tendon rupture due to occupational repetitive direct trauma to the dorsal compartments of the wrist and hand is reported in a woman. Tenosynovectomy and tendon transfer were performed to relieve pain and restore hand function.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of intra-articular morphine and bupivacaine following knee arthroscopy.
A prospective study was conducted to investigate and compare the analgesic effect of morphine and bupivacaine injected intra-articularly following elective knee arthroscopy performed under general anesthesia without the use of a tourniquet. Cost-effectiveness of these agents was also evaluated. ⋯ Results showed that patients in Group 2 reported significantly less pain overall (P < .006) and significantly lower analgesic requirements (P < .0004) at a lower average patient cost than Group 1. We conclude that intra-articular morphine reduces postoperative pain and analgesic requirements more effectively and at a lower average patient cost than bupivacaine.
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Review Case Reports
Displaced Salter-Harris type I injury in a gymnast. A slipped capital humeral epiphysis?
The case of an adolescent Olympic-level gymnast with insidious onset shoulder pain is presented. Radiographic evaluation revealed bilateral physeal irregularities of the proximal humerus similar to those seen in Little Leaguer's shoulder. Roentgenograms of the involved shoulder also demonstrated Salter-Harris type I displacement at this physis and a slipped capital humeral epiphysis was diagnosed. A discussion reviewing proximal humeral physeal injury follows the case presentation.
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Regional nerve block anesthesia has been less commonly used and less successful in surgery on the lower extremity than on the upper extremity because of anatomic difficulties associated with lower-extremity nerve blockade. The authors have developed a technique that combines two peripheral nerve blocks with a nerve stimulator. ⋯ The technique has also facilitated rapid patient discharge from the same-day unit. No significant complications have been encountered.
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Spinal column injuries to the thoracolumbar region are common and leave one fifth of patients with neurological deficit. The authors describe a case of complete fracture-dislocation at lumbar 1-2 level with paraplegia. They detail their surgical technique for reduction, stabilization, and fusion using pedicle screws and plates. Surgical management of such injuries allows rapid rehabilitation of patients with spinal column injuries.