In a prospective, randomised study we have compared the pertrochanteric external fixator (PF) with the sliding hip screw (SHS) in 100 consecutive patients who were allocated randomly to the two methods of treatment. Details of the patients and the patterns of fracture were similar in both groups. Follow-up was for six months. Use of the PF was associated with significantly less blood loss, a shorter operating time, reduced postoperative pain, shorter hospitalisation (p < 0.001), earlier mobilisation (p < 0.001) and a reduced rate of mechanical complications (p < 0.01). Superficial infection was significantly more common with the PF (p < 0.01), but without long-term adverse consequences. There were no differences in the healing of the fracture, mortality or final functional outcome. Our results indicate that the external fixator is an effective and safe device for treating pertrochanteric fractures and should be considered as a useful alternative to conventional fixation with the sliding hip screw.

In 44 surgical high-risk patients (ASA grade 3 or 4) pertrochanteric fractures were treated with a newly developed external fixator; all fractures healed within 14 weeks. Seven patients had a superficial pin tract infection and in 12 patients the fracture united with a shortening of 18 (5-30) mm. No implant failures or limitation of knee movements were recorded. Nine patients died during the first 6 months. The "pertrochanteric fixator" is a valuable alternative for treating highrisk, elderly patients.Résumé Chez 44 patients présentant des problèmes médicaux majeurs (ASA grade 3 ou 4) nous avons utilisé un nouveau "fixateur trochantérien". Toutes les fractures ont consolidé en 14 semaines. Les complications à noter ont été l'infection superficielle des fiches (7 patients) et le raccourcissement du membre inférieur de 18 (5-30)mm (12 patients). Il n'y a pas eu de complications liées au matériel (rupture ou lâchage des fiches) ni de limitation de mobilité du genou. La mortalité observée a été 21% en 6 mois. Le "fixateur trochantérien" est une alternative valable pour des patients âgés à risque opératoire très élevé.

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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.

A novel technique for managing ruptured tibialis anterior tendon complicated by infection and tendon substance loss in a young adult is described. A two-stage reconstruction technique with a silicon tube and tendon autograft was performed. At first, after local control of the infection, scar excision and placement of a silicone tube was performed. Ten weeks later, ipsilateral hamstrings tendons were harvested and bridged the 7 cm tendon gap. Eighteen months later, the patient has excellent clinical and functional outcome.