To show that the treatment of buckle fractures of the distal radius in children in a soft bandage is an effective and safe method of treatment, a randomized prospective trial was undertaken. Patients entered the trial after diagnosis in the accident and emergency department. Allocation to either plaster cast or bandage was random. Bandage patients were seen each week. Plaster cast patients were seen at 4 weeks. Measurements were taken at all visits. Patient questionnaires were completed at the end of treatment. Thirty-nine patients completed the study. Eighteen were allocated to bandage, 21 to plaster cast. Those in bandage showed an excellent range of movement by the first week. Results were highly positive for treatment in bandage, with no reported adverse effects and a highly desirable result for the patient. The authors would suggest a change in treatment policy for such fractures.
The UniCAT protocol uses less radiation than whole-limb spiral scans and is a method that can be used with all modern computer-assisted tomography machines. The coronal and sagital alignment results compare favourably with previous published reports without computer-assisted tomography. Component rotation has not previously been reported and its implications are yet to be defined.
The use of a Rhys-Davies (R-D) mechanical exsanguinator prior to the application of tourniquet is routine clinical practice in knee arthroscopy. However, this technique has been reported to cause injuries and is contraindicated in conditions like malignancy and latex allergy. Lower limb elevation alone has also been described as a technique of exsanguination. We conducted a prospective audit of two groups of patients (25 each) undergoing routine knee arthroscopy comparing the practice of mechanical exsanguination (R-D) with lower limb elevation technique. Average total operative times of the two groups were similar (R-D exsanguinator-23 min, limb elevation-21 min, n.s). Time interval between tourniquet inflation and skin incision was significantly lower in limb elevation technique (R-D exsanguinator-5 min, limb elevation-0.2 min, P < 0.001). Limb elevation technique of exsanguination helps avoid the risks associated with mechanical exsanguination and may potentially reduce the non-operative tourniquet application time.
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