No abstract

The use of passive stretching of the elbow after arthrolysis is controversial. We report the results of open arthrolysis in 81 patients. Prospectively collected outcome data with a minimum follow-up of one year were analysed. All patients had sustained an intra-articular fracture initially and all procedures were performed by the same surgeon under continuous brachial plexus block anaesthesia and with continuous passive movement (CPM) used post-operatively for two to three days. CPM was used to maintain the movement achieved during surgery and passive stretching was not used at any time. A senior physiotherapist assessed all the patients at regular intervals. The mean range of movement (ROM) improved from 69° to 109° and the function and pain of the upper limb improved from 32 to 16 and from 20 to 10, as assessed by the Disabilities of the Arm Shoulder and Hand score and a visual analogue scale, respectively. The greatest improvement was obtained in the stiffest elbows: nine patients with a pre-operative ROM < 30° achieved a mean post-operative ROM of 92° (55° to 125°). This study demonstrates that in patients with a stiff elbow after injury, good results may be obtained after open elbow arthrolysis without using passive stretching during rehabilitation.

Since its introduction in the early 1990s, the laparoscopic cholecystectomy has become the standard surgical intervention for cholelithiasis. The laparoscopic technique is being used in an increasing number of abdominal procedures. Intestinal volvulus is a rare complication of laparoscopic procedures, such as the laparoscopic cholecystectomy. A review of the literature revealed 12 reports of this complication occurring without a clear cause. Etiologic factors that have been postulated include congenital malrotation, previous surgery, and intraoperative factors, such as pneumoperitoneum, mobilization of the bowel, and patient position. In this paper, we review the literature for this rare complication and report on a case of cecal bascule (a type of cecal volvulus) occurring following the laparoscopic cholecystectomy. Of the 12 prior reports of intestinal volvulus following laparoscopic procedures, 8 of these followed the laparoscopic cholecystectomy, of which two were cecal volvulae. This is the first reported case of a cecal bascule occurring following the laparoscopic cholecystectomy.

The purpose of the study was to assess the quality of life, physical function, self-motivation, and self-perception of skeletally mature patients with spina bifida and scoliosis. This is a prospective study on 19 skeletally mature patients with a mean age of 21.4 years. Several questionnaires were used for the study: Activities Scale for Kids, Quality of Life in Spina Bifida Questionnaire, The Health Self-Determinism Index for Children, Harter's Self-Perception Profile for Adolescents, and the Spina Bifida Spine Questionnaire. This study found no association between spinal deformity or other features related to spina bifida and self-perception, motivation, and overall physical function. More severe scoliosis affects quality of life and is related to the degree of pelvic obliquity and the age of the patients. Individuals with motor-level dysfunction below L3 had significantly better overall physical function compared with those with a higher level of lesions. This was the only factor found to affect physical function. Our findings suggest that most limitations in patients with spina bifida are not related to the degree of scoliosis but to other associated disabilities.

Despite obtaining normal sonograms at the end of treatment, some children with type IIb dysplasia may demonstrate radiographic evidence of persistent hip dysplasia over a longer follow-up period. Our results suggest that these children should be monitored until skeletal maturity.