BackgroundTears of the medial meniscus posterior root can lead to progressive arthritis, and its management has no consensus. The aim of our study was to evaluate the effect of supervised exercise therapy on patients with medial meniscus posterior root tears.Materials and methodsBetween January 2005 and May 2007, 37 patients with this tear verified by magnetic resonance imaging (MRI) and osteoarthritis grade 1–2 by radiographic examination were treated by a short course of analgesics daily for up to 6 weeks and then as required during follow-up, as well as a 12-week supervised exercise program followed by a home exercise program. Final analysis was performed for 33 patients, average age 55.8 (range 50–62) years and average follow-up of 35 (range 26–49) months. Patients were followed up at 3, 6, and 12 months and yearly thereafter using the Lysholm Knee Scoring Scale, Tegner Activity Scale (TAS), and visual analog scale (VAS). The analysis was performed using one-way analysis of variance (ANOVA) and Pearson’s correlation coefficient to determine the relationship between Lysholm score and body mass index (BMI).ResultsPatients showed an improvement in Lysholm score, TAS, and VAS, which reached maximum in 6 months and later was accompanied by a decline. However, scores at the final follow-up were significantly better than the pretherapy scores. There was also a progression in arthritis as per Kellgren and Lawrence radiographic classification from median 1 preintervention to median 2 at the final follow-up. A correlation between BMI and Lysholm scores was seen (r = 0.47).ConclusionSupervised physical therapy with a short course of analgesics followed by a home-based program results in symptomatic and functional improvement over a short-term follow-up; however, osteoarthritis progression continues and is related to BMI.
It was concluded that pain perception was significantly more during traditional palatal infiltration injection as compared to computerized palatal infiltration, while there was no difference in pain perception during buccal infiltration in both the groups.
Lumbar puncture in newborns produces pain responses. Eutectic mixture of local anesthetics is an efficacious agent for reducing the pain associated with needle insertion and withdrawal during lumbar puncture in newborns.
BackgroundComplications that develop after femoral neck fracture in children—especially osteonecrosis—have been retrospectively attributed to inadvertent delayed fixation and fracture type. Prospective evaluation of results after delayed fixation of femoral neck fractures in children beyond the first 24 h is not reported in the literature and requires evaluation to increase our understanding of the procedure and improve fixation methods. Also, the role of capsular decompression in initial management needs to be elucidated.Materials and methodsRadiological and functional evaluation was done for delayed fixation (>24 h) of displaced fractures in the femoral neck in 21 children (21 hips) treated over 11 years. Mean patient age was 11.8 (median 12, range 5–15) years. Extraphyseal fixation was done using partially threaded cannulated cancellous screws after closed or open reduction. Patients were allowed full weight bearing after 12–18 weeks. Results were assessed on the basis of modified Ratliff criteria. Patients were followed for a mean of 81 (range 66–129) months.ResultsAll fractures united at a mean duration of 12 (range 10.6–14) weeks. Three (14.3%) patients had osteonecrosis of the hip, which was significantly related to poor outcome (r = 0.495; P = 0.022). There was a significant correlation (r = 0.52) between development of osteonecrosis and delayed fracture fixation of >10 days (P = 0.016) and open reduction (P = 0.016).ConclusionsOutcome following temporal delay in fracture fixation of the femoral neck is primarily affected by osteonecrosis of the femoral head, whereas restriction of movements, shortening, and premature physeal closure has no significant influence. Osteonecrosis is primarily linked to delay and open reduction, whereas fracture type, age, and sex seem insignificant factors. Capsular decompression does not seem to affect the outcome in delayed presentations and may hinder definitive treatment.
The care of the older person with hip fracture is complicated by their comorbid condition, limited physiological reserve, cognitive impairment and frailty. Two aspects of hip fracture management that have received considerable attention are how best to manage the pain associated with it and the ideal mode of anaesthesia. Existing literature has reported on the suboptimal treatment of pain in this orthogeriatric cohort. With recent advancements in medical care, a number of options have emerged as alternatives to conservative systemic analgesia. Systemic analgesia, such as opioids, can lead to untoward side effects, especially in this particular group of patients. Hence, peripheral nerve blocks, epidural analgesia and regional anaesthesia have emerged as options in the delivery of adequate pain relief in hip fractures. Besides that, there is ongoing debate regarding the appropriate anaesthesia technique for surgical repair of the fractured hip. The benefits and risks related to either spinal anaesthesia or general anaesthesia have been subject to studies determining which method is associated with better short- and long-term outcomes. In this review, we aim to examine the evidence behind the different analgesia options available, compare spinal and general anaesthesia, and discuss the importance of the multidisciplinary orthogeriatric model of care in hip fracture and its potential role in other fragility fractures.
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