The authors present their intraoperative and postoperative experience in using intramuscular infiltrations with analgesic and anesthetic substances as pain control methods in patients that undergo hip surgery: arthroplasty or hemiarthroplasty. A total of 30 patients that have undergone either an elective total hip arthroplasty surgery or hemiarthroplasty of the hip following a hip fracture, since May 2018 until August 2018. The patients were divided in two equal groups, one group that followed through the protocol and one control group. The intramuscular infiltrations were administered intraoperatively at the timeline of the muscle suture and contained: Bupivacaine 10 mL + Morphine 1 mL + Methylprednisolone 40mg. Postoperative protocol used the visual analogue scale (VAS) pain scores on days 1, 2, 3, 4, 5, 6 and 7 for measuring the postoperative pain control. Intraoperative intramuscular infiltrations, with an analgesic and anesthetic cocktail consisting of Bupivacaine, Morphine and Methylprednisolone, for patients that are going through hip surgery are safe to use with very good results in terms of postoperative pain control. We reduced the consumption of opioids and analgesic drugs, which indirectly leads to decreased direct cost per patient. Another important benefit was an early active mobilization of the patient, with shorter hospitalization time. All things considered, using regional anesthesia and multimodal pain management techniques may lead to a nearly painless hip surgery.

Objectives The aim of our study was to assess the incidence of night-time voiding in a population of male patients with hip fracture, and to analyze the correlations between the severity of the lower urinary symptoms and the other most significant comorbidities of the patients. Patients and methods We have initially selected a group of patients containing all males admitted into a Department of Orthopedic Surgery with the diagnosis of hip fracture, with indication for replacement surgery, over a four-year period. Applying well-defined inclusion and exclusion criteria, we have selected all the patients who have reported that falling during the night, on the way to the toilet (for micturition), was the event leading to the hip fracture. A comprehensive medical history and the International Prostate Symptom Score (IPSS) Questionnaire were gathered from all the patients and the obtained data were analyzed. Results From a total of 363 patients with hip fractures, 68 cases were attributable to night-time voiding. The detailed analysis of the 68 patients has shown that all of them had significant nocturia (2.72 episodes of voiding per night, in average), but only 11 of them were already diagnosed with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Moreover, only four of the eleven patients diagnosed with BPH were taking specific therapy at the moment of their falling leading to hip fracture. Subsequent analysis has shown that a group of 45 patients with no previously known co-morbidities, had similar IPSS score results with the total group of 68 patients. Conclusions Night-time voiding and LUTS are underdiagnosed in the general male population, as they represent significant risk factors for hip fractures due to falling during the night. The low level of BPH/LUTS therapy adherence adds a supplementary risk for falling during the night.

Psychosocial support is an important part of comprehensive care for people with hemophilia. Beyond the medical condition, individuals with hemophilia commonly face a number of psychosocial challenges. Social workers, psychologists and counsellors play a key role in helping new patients and their families adapt and learn to cope with their new reality. It is possible to have hemophilia and still live a full life, even for those who face many social and economic challenges. Medical treatment alone does not automatically translate into better quality of life. Beyond medical treatment, the responsibilities of the hemophilia treatment centre include educating families about how to manage hemophilia and helping them find interventions for psychosocial issues.

The rare anatomic variants of the celiac trunk and superior mesenteric artery include the hepatosplenic, hepatosplenomesenteric (HSMT), celiacomesenteric, hepatomesenteric and gastrosplenic trunks. We report a 72-year-old female patient whose computed tomography angiograms indicated a rare anatomic feature whereby the right inferior phrenic artery was inserted in the origin of an HSMT, thus modifying it into a hepatosplenomesentericophrenic trunk (HSMPT). Above the HSMPT, the insertion of the left inferior phrenic artery in the origin of the left gastric artery determined a left gastrophrenic trunk (GPT). Proper identification of this type of rare anatomic variant is of utmost importance prior to different surgical procedures. For example, an HSMT origin of the right inferior phrenic artery is surgically relevant if this artery is an extrinsic pedicle of a hepatocellular carcinoma and is used for embolization of the tumor.

The aim of our study was to investigate the accuracy of dynamic ultrasound assessment of the anterior tibial translation, in diagnosing anterior cruciate ligament tears, and to assess its test–retest reliability. Twenty-three patients (32 ± 8.42 years; 69.56% males) with a history of knee trauma and knee instability participated in the study. Knee ultrasound was performed by an experienced orthopedic surgeon. The anterior tibial translation was measured in both knees and differences between the injured and uninjured knee were calculated. Side-to-side differences > 1 mm were considered a positive diagnosis of an ACL tear. The anterior tibial translation values were 3.34 ± 1.48 mm in injured knees and 0.86 ± 0.78 mm in uninjured knees. Side-to-side differences > 1 mm were found in 22 cases (95.65%). The diagnosis accuracy was 91.30% (95%CI: 71.96–98.92%) and sensitivity 95.45% (95%CI: 77.15–99.88%). The intraclass correlation coefficient showed an excellent test–retest reliability (ICC3,1 = 0.97 for the side-to-side difference in anterior tibial translation). The study highlights the accuracy and reliability of the dynamic ultrasound assessment of the anterior tibial translation in the diagnosis of unilateral anterior cruciate ligament tears. Ultrasound assessment is an accessible imaging tool that can provide valuable information and should be used together with physical examination in suspected cases of ACL injuries.