To compare outcome between the medial and posterior approaches for the surgical treatment of supracondy-lar fractures when performed by two experienced surgeons. A retrospective analysis of 45 children, mean age of 5.5 years (2.5-11 years), treated for closed Wilkins IIB/III supracondylar fractures without vascular deficit between January 1999 and December 2004. Twenty-one and twenty-four children were treated using the medial and posterior approaches respectively. The medial approach is quicker but technically demanding. The posterior approach is easier but cuts through the intact posterior structures. In both groups the fracture was stabilised using crossed K-wires and the arm was immobilised in an above elbow backslab for 3 to 4 weeks. Follow-up was at 3 to 4 weeks, 3, 6, and 9 months, and at 1 year. The results were assessed clinically using Flynn’s classification and radiologically using the metaphyseal-diaphyseal and humerocapitellar angles. There was no post-operative infection or redisplace-ment. Clinically, the medial approach gave 18 excellent, 2 good, and one fair result, and the posterior approach gave 21 excellent, 2 good, and one fair result (P>
0.50). Radiologically, the medial approach gave 18 excellent and 3 good results, and the posterior approach gave 20 excellent and 4 good results (P>
0.50). We found no significant difference in outcome between the two approaches, both giving mostly excellent long term results. Each approach has its known merits and drawbacks. This type of fracture needs an experienced surgeon comfortable with his preferred approach.
Patients were 36 male and 84 females with the mean age at the time of revision surgery was 71.4 years (range 42 – 89 SD 9.7). In all the patients their indication for revision surgery was aseptic loosening. All the patients had impacted morsellised bone allograft as part of the reconstruction used with cemented prostheses. Clinical and radiological assessments of all patients were conducted for average of four years follow up.
Sensitivity of clinical examination for all tears was 69%, with a specificity of 64% and a positive predictive value of 80%. Individual sensitivities were as follows: grade I 50%, II 76%, III 100%. MRI had a sensitivity of 82.8% for all tears, specificity of 57% and a positive predictive value of 80%. Individual sensitivities: I 69%, II 90%, III 100%.
It recommended that 100% patients should be satisfied with the management of their pain and any side effects of analgesic treatment. We conducted this prospective study to compare effectiveness of combining local nerve blocks with PCA (patient controlled analgesia) morphine to PCA morphine only in controlling acute post operative pain among total knee arthroplasty patients.
It involves 50 Patients underwent total knee replacement. Average patient age 71y (range 53–83y) Patients divided into two groups: (A) – PCA (patient controlled analgesia) Morphine only and (B) – PCA Morphine + local nerve Blocks Data collected: Pain score at 1,3,6,12,24 hrs after operation, Morphine used, Supplementary analgesia, Side effects (vomiting score), Patients satisfaction, Patients’ knee joint early range of movement and Patients average period of hospital stay.
Side effects was seen in 30% in group B compared to 45% in group A There was no difference in the knee joint early range of movement There was no difference in the patients’ average period of hospital stay.
We recommend that more total knee arthroplasty patients should be offered local nerve blocks in addition to their standard anaesthesia.
The BOA recommends clinical and radiological follow-up at þve-yearly intervals in order to detect failing implants. We support this recommendation and have shown that with longer followÐup the assessment of demarcation in all three zones has substantial agreement