PRP appeared to enable biological healing of the lesion, whereas CS appeared to provide short-term, symptomatic relief but resulted in tendon degeneration.

No abstract

A few cases of fire in the operating room are reported in the literature. The factors that may initiate these fires are many and include alcohol based surgical prep solutions, electrosurgical equipment, flammable drapes etc. We are reporting a case of fire in the operating room while operating on a patient with burst fracture C6 vertebra with quadriplegia. The cause of the fire was due to incomplete drying of the covering drapes with an alcohol based surgical prep solution. This paper discusses potential preventive measures to minimize the incidence of fire in the operating room. Case presentationA 25 years old male patient with burst fracture of C6 vertebra with quadriplegia was taken to the operating room for anterior decompression with fusion. He was positioned supine on the operating table. The neck, shoulder region and the upper part of chest up-to the level of nipples was shaved. General anesthesia was induced and the patient was intubated for intra-operative ventilation using closed circuit. The neck, shoulder and chest region was painted with Cutasept R (contains Benzalkonium chloride and Isoproponol 63%). The surgical site was draped with cotton sheets. A longitudinal incision was given along the anterior border of sternomastoid and the subcutaneous tissue was exposed. Electrocautery was then brought into the field for deeper dissection. Flames were noticed around the surgical site immediately after the activation of the electrocautery. The flames were spread over the entire surgical field corresponding to the area prepared with Cutasept R . The drapes were immediately removed and the electrocautery was switched off. The fire was rapidly extinguished within seconds. The patient suffered minor burns in the neck and chest region (first degree) and recovery was uneventful. DiscussionOperating room fires are uncommon. Studies by Emergency Care Research Institute have shown that approximately 100 operating room fires occur every year with 10-20 of these events deemed "serious" and two directly resulting in death. Nearly 70% of these fires are related to the use of electro surgical equipment. Furthermore, in 72% of cases, an oxygen-enriched atmosphere has been shown to have contributed to the fire. It has also been noticed that there is a significant risk of fire when alcohol based surgical prep solutions are used for skin preparation [1][2][3]. The fact that alcohol based antiseptic solutions can provide fuel for surgical fire has been demonstrated both by reports of surgical fires and laboratory studies [4,5].The fire triangle is a useful construct that describes the three elements necessary for initiation of a fire i.e., heat, fuel and an oxidizer. In the case of operating room fires, an electrosurgical unit most often provides heat to ignite

Purpose Medial pivot (MP) total knee arthroplasty (TKA) aims to restore native knee kinematics due to highly conforming medial tibio-femoral articulation with survival comparable to contemporary knee designs. Posterior stabilized (PS) TKAs use cam-post mechanism to restore native femoral rollback. However, there is conlicting evidence regarding the reported patient satisfaction with MP TKA designs when compared to PS TKAs. The primary aim of this study is to compare the patient satisfaction between MP and PS TKA and the secondary aim is to establish potential reasons behind any diferences in the outcomes noted between these two design philosophies. Methods In this IRB-approved single surgeon, single centre prospective RCT, 53 patients (mean age 62 years, 42 women) with comparable bilateral end-stage knee arthritis undergoing simultaneous bilateral TKA were randomized to receive MP TKA in one knee and PS TKA in the contralateral knee. At 4 years post-surgery, all patients were assessed using Knee Society Score (KSS)-Satisfaction and -Expectation scores, and Oxford Knee Score (OKS). In addition, all the patients underwent standardized radiological and in vivo kinematic assessment. Results Patients were more satisied with the MP TKA as compared to PS TKA: mean KSS-Satisfaction [34.5 ± 3.05 in MP and 31.7 ± 3.16 in PS TKAs (p < 0.0001)] and mean KSS-Expectation scores [12.5 ± 1.39 in MP TKAs and 11.2 ± 1.41 in PS TKAs (p < 0.0001)]. No signiicant diference was noted in any other clinical outcomes. The in vivo kinematics of MP TKAs was signiicantly better than those of PS TKAs. Conclusion MP TKAs provide superior patient satisfaction and patient expectations as compared to PS TKA. This may be related to better replication of natural knee kinematics with MP TKA. Level of evidence I.

Background The relationship of the radial nerve is described with various osseous landmarks, but such relationships may be disturbed in the setting of humerus shaft fractures. Alternative landmarks would be helpful to more consistently and reliably allow the surgeon to locate the radial nerve during the posterior approach to the arm. Questions/purposes We investigated the relationship of the radial nerve with the apex of triceps aponeurosis, and describe a technique to locate the nerve. Materials and MethodsWe performed dissections of 10 cadavers and gathered surgical details of 60 patients (30 patients and 30 control patients) during the posterior approach of the humerus. We measured the distance of the radial nerve from the apex of the triceps aponeurosis along the long axis of the humerus in cadaveric dissections and patients. This distance was correlated with the height and arm length. For all patients, we recorded time until first observation of the radial nerve, blood loss, and postoperative radial nerve function. Results The mean distance of the radial nerve from the apex of the triceps aponeurosis was 2.5 cm, which correlated with the patients' height and arm length. The mean time until the first observation of the radial nerve from beginning the skin incision was 6 minutes, as compared with 16 minutes in the control group. Mean blood loss was 188 mL and 237 mL, respectively. With the numbers available, we observed no difference in the incidence of patients with postoperative nerve palsy: none in the study group and three in the control group. Conclusion The apex of the triceps aponeurosis appears to be a useful anatomic landmark for localization of the radial nerve during the posterior approach to the humerus. IntroductionOwing to an increase in high-energy trauma cases, the incidence of fractures of the humerus diaphysis is increasing. Operative treatment of humeral fractures, especially the distal third region, chronic osteomyelitis of the distal third of the humerus requiring sequestrectomy and radial nerve palsy requiring exploration, usually requires a posterior approach to the humerus. This approach causes iatrogenic radial nerve injury in 0% to Each author certifies that he has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.