Small hospitals often lack the financial and personnel resources to realize innovative postoperative pain management concepts. This is not-as shown here-an absolute contradiction. The regular measurement of pain and its documentation by ward nurses as well as the appropriate prescription of analgesics play a key role in our concept. The joint establishment of guidelines, information sessions and the on-going dialog between the various professional groups guarantees the necessary consensus of all specialists involved in postoperative pain control. If an anesthetist is available 24 h a day, a nurse-based acute pain service (APS) becomes available for managing patients with patient-controlled analgesia (PCA) systems. The use of PCA and the performance of pain visits at regular intervals increase patient comfort and satisfaction. In addition, it can contribute to reduced hospitalization time in the context of fast-track rehabilitation programs. In our opinion, embedding the measures in a quality management program has a valuable catalytic effect, although implementation takes at least 1-2 years.

A simple and easy method of CT-measurement of humeral torsion is proposed. This requires a transverse section of the proximal and distal epiphyses. The optimal site of cross-sectioning with reliable construction of the joint axis was determined in ten humeral bones. The variability of the angle was 2 to 3 degrees. Comparing CT-measurements in 50 humeri with anthropometry showed excellent correlation. Varation in humeral torsion on either side was approx. 50 degrees with the same mean value in right and left humeri of our specimens. Deviations in bone positioning within the gantry of up to 15 degrees in two different planes had little effect on the measurements. Habitual dislocation of the shoulder as well as assessment of postfractural malrotation of the humerus might be indications for measurement of humeral torsion.