Reducing the pain associated with local anaesthetic infiltration for open carpal tunnel decompression

This prospective, randomized study assessed the effectiveness of buffering lidocaine with sodium bicarbonate for reducing the pain associated with local anaesthetic infiltration for open carpal tunnel decompression. Twenty-one patients undergoing bilateral open carpal tunnel decompression received, in a randomized manner, lidocaine 1% with adrenaline (1:200,000) in one hand and the same local anaesthetic buffered with 8.4% NaHCO3 at a 5:1 ratio in the other hand. Pain, especially its burning element, was evaluated on a visual analogue scale and was significantly reduced with the buffered solution. The buffering was effective for all patients and no adverse effects were noted. This is a safe, easy and quick method for making open carpal tunnel surgery less uncomfortable to patients

Hemiarthroplasty for three- and four-part displaced fractures of the proximal humerus in patients over 65 years of age

This is a prospective case series, in which the outcome of shoulder hemiarthroplasty in recent three- and four-part fractures of the proximal humerus was evaluated in patients over 65 years of age. From February 1993 to October 2002, 51 patients with 3- or 4-part fractures of the proximal humerus were entered into the study. The criteria for inclusion were age over 65 years and 3- or 4- part displaced fracture. The mean age of the patients was 73 years (range 65 to 84). The mean follow-up was 5.5 years (range 2 to 12). According to the Constant-Murley scale, the results were satisfactory or very satisfactory for 74% of the patients. Thirty nine patients (78%) experienced mild or no pain, 50% achieved active anterior elevation greater than 120 degrees, while 40% had active lateral elevation of more than 120 degrees. None of the patients experienced complete recovery of strength and full range of motion. Thirty four patients were able to resume all their daily activities. There were complications in 26% of the patients. Assessment following the Constant-Murley scale demonstrated that two thirds of the patients were pain free and regained a wide range of shoulder movement, while one third resumed their pre-fracture activities to a great extent. The majority of the patients did not recover normal strength

The effect of osteoporotic treatment on the functional outcome, re-fracture rate, quality of life and mortality in patients with hip fractures: A prospective functional and clinical outcome study on 520 patients

Numerous high quality studies have shown the positive effects of various osteoporotic medical treatment regimens on bone mass and on the reduction of risk for new spinal, hip and non-spinal fractures in osteoporotic patients. However, the effect of osteoporotic treatment on the functional and clinical outcome of patients who have sustained hip fractures and been treated surgically has not yet been addressed. Five hundred and twenty patients out of 611 who were admitted (2009-2011), operated on due to a hip fracture and completed their follow-up evaluations were included in this study. Data related to functional outcome scores, re-fracture rate, quality of life and mortality rate were prospectively recorded, analysed and correlated to osteoporotic medical treatment. There were 151 (25%) men and 369 (71%) women with a mean age of 80.7 years (range, 60 to 90 years). At a mean follow-up of 27.5 months (range, 24 to 36 months) a mortality rate of 23.6% at 2 years was recorded. Mean values of functional and quality of life scores were found to have progressively improved within two years after surgery. Seventy-eight (15%) patients were taking osteoporotic treatment before their hip fracture and 89 (17.1%) started afterwards. Osteoporotic treatment proved to be an important predictor of functional recovery (all p values < 0.05), re-fracture rate (p = 0.028) and quality of life (EQ-5D, all dimensions, p values < 0.05). Osteoporotic treatment did not affect post-fracture mortality rates. Osteoporotic treatment taken before or initiated after fracture is a strong predictor of functional and clinical outcome in patients with hip fractures treated surgically. (C) 2014 Published by Elsevier Ltd

Clinical Outcome Study and Radiological Findings of Zweymuller Metal on Metal Total Hip Arthroplasty. A Follow-up of 6 to 15 Years

We report the clinical and radiological outcome of 99 Zweymuller metal on metal total hip arthroplasties in 84 patients followed up prospectively for a mean period of 9.5 (range, 6-15) years. There were 29 (34.5%) male and 55 (65.5%) female patients with a mean age of 62.85 years (range, 50-70 years) at the time of surgery. All patients had osteoarthritis. One acetabular component and one stem were revised due to aseptic loosening. One femoral stem was revised due to a periprosthetic fracture. HHS score improved from a preoperative mean of 62.56 points (SD 8.87) to a final postoperative follow-up mean of 93.48 (SD 7.7). Cumulative success rate for both implants at 13 years, with aseptic loosening as the end point, was 97.05%, while for both implants at 13 years, with revision for any reason as the end point, it was 91.17%. Satisfactory results were observed with the use of this prosthesis. (Hip International 2009; 19: 301-8

Management of trochanteric fractures of the femur with external fixation in high-risk patients

The aim of this prospective study was to assess the outcome of trochanteric fractures of the femur after external fixation in a group of elderly patients with high surgical risk. The study population consisted of 50 patients with trochanteric fractures of the femur and a mean age of 87 years who were classified by an anaesthetist as ASA 3 or 4 and considered not suitable for conventional fractures fixation. The fracture was fixed with an external fixator under spinal anaesthesia. The final follow-up was at 12 months. All fractures healed within 12 weeks. Superficial pin tract infection occurred in 30 patients, and fracture united with a shortening of 14 mm (5–20) in 12 patients. No implant failures or limitation of knee movements were recorded. Five patients died within 1 year. External fixation is a valuable treatment alternative for trochanteric fracture of the femur in elderly patients