Local anaesthetic injections are regularly used for perioperative pain relief for shoulder arthroscopies. In our practice all shoulder arthroscopies were performed under general aneasthesia supplemented by perioperative subacromial local anaesthetic injections or landmark guided axillary nerve together with suprascapular nerve injections. We compared pain relief achieved with these two methods. We hypothesized that the selective nerve blocks would provide better post operative pain relief as described in literature. We conducted a retrospective cohort study on two patient groups with 17 patients each. Group one patients received 20mls 50:50 mixture of 1% lignocaine and 0.5% chirocaine injections before and after start of procedure and group two patients received 20 mls of chirocaine around the axillary and suprascapular nerves. VAS scores were collected at 1 and 4 hours and analgesia taken during the first 24 hours was recorded.Abstract
Introduction
Methods
Distal radius fractures are commonest injury managed by junior doctors in accident and emergency department. Technique of manipulation is very well described and doctors are prepared from the days of medical school. Though manipulation is done in good position at initial management many patients require re-manipulation and surgical stabilisation due to loss of position on subsequent examination. Many Senior surgeon thinks this is due to inadequate plastering and moulding technique.
Internal fixation of ankle fractures should be undertaken either before or after the period of critical soft tissue swelling. As part of the clinical governance in our unit, an audit was undertaken to examine the interval between admission and surgery and net inpatient stay of patients with ankle fractures over a 6 month period. Thirty four patients fulfilled the inclusion criteria of having an acute closed fracture of the ankle requiring open reduction and internal fixation (ORIF). There were 16 unimalleolar, 10 bimalleolar and 8 trimalleolar fractures. 10 Patients underwent surgery on the day of admission, 9 patients had surgery within 24 hours, 15 patients had surgery after 24 hours of admission. The average in patient stay was 9 days (1–61 days). If surgery was undertaken within 24 hours the average inpatient stay was 9 days (1–14). If surgery was delayed beyond 24 hours the average inpatient stay was 15 days (3–61 days). Delayed surgery of closed ankle fractures increases the risk of soft tissue complications and prolongs hospital stay with profound cost implications. Long-term disability resulting from ankle fractures can be reduced by optimal early management procedures.
Thigh pain and periprosthetic osteolysis associated with the femoral stem, is a common complication of cementless total hip arthroplasty. Treatment of this disabling complication is difficult but usually requires revision of the femoral stem, which is a procedure not without further morbidity. We describe a solution which does not require revision and which brought about resolution of the thigh pain. The patient was a 79 year old male who had a primary Total hip replacement (year 1998),This was revised (early 2001) to an uncemented cup (ABG type) and uncemented femoral component (Link MP stem) . He continued to experience disabling thigh pain which limited walking to only a few yards.The pain was thought to be related to concomitant paget’s disease in the Right hemipelvis and proximal femur. Rheumatology assessment and treatment with IV Pamidronate (three courses of treatment) did not produce any relief of pain and indicated a mechanical prosthesis related cause of pain. Radiology assessment was also indicating the same with osteolysis at the tip of the prosthesis. The patient did not want a further revision procedure, but wanted relief of pain.Therfore sufgicsl intervention to treat the osteolysis with allograft ground bone introdued retrogradely via an anterior knee approach with an intercondylar pilot hole and initial supracondylar reaming. Allograft was introduced using a 5 ml syringe and impacted with a 1 cm diameter metal rod. 50 ml of ground bone was introduced and impacted forcibly with rod and hammer impaction. The knee wound was closed in layers over 2 drains and post-op management was same as for total knee replacement, CPM and active NWB mobilization for six weeks followed by PWB, progressing to full weight bearing mobilization. Walking was free of thigh pain and walking distance was improved.