Seyed Mohammad Javad Mortazavi, MD.
Vol 6, No 4 (2020)
Comparison of Pain on Injection of Etomidate versus Etomidate-Lipuro in Patients Undergoing Elective Orthopedic Surgery: A Double-Blind Randomized Clinical Trial
Background: Etomidate is an efficient general anesthetic associated with injection pain. Etomidate-Lipuro is its lipid emulsion, suggested to have less adverse effects. We aim to compare the injection pain of etomidate vs. etomidate-lipuro.
Methods: This double-blind randomized clinical trial investigated 46 hands (23 patients) undergoing elective orthopedic surgery referring to our hospital from May to September 2017. For each patient, intravenous (IV) access was put on both hands, on one of which 2 ml of etomidate (drug A) and on the other one, 2 ml of etomidate-lipuro (drug B) were infused simultaneously. Pain scores were compared between drug types by the Wilcoxon signed-rank test using the SPSS software.
Results: Among 23 patients included in the study, 8 (34.8%) were female. Mean ± standard deviation (SD) of the patients’ age was
40.52 ± 13.07 years (range: 22-60 years). The type of drug injected to the right hand was drug A in 14 hands (60.9%) and drug B in 9 hands (39.1%). Mean ± SD of pain scores was 3.57 ± 3.30 for drug A (P < 0.001). The hand side (left/right) showed no significant effect on the pain scores (P = 0.535).
Conclusion: This randomized clinical trial used each person as his/her own control (left/right hands). Given the results, etomidate-lipuro showed significant superiority over etomidate regarding injection pain. In fact, most patients felt no pain, which suggests etomidate-Lipuro as an appropriate sedative.
Primary Total Hip Arthroplasty versus Open Reduction and Internal Fixation in Displaced Fracture of Femoral Neck in Adults
Background: Femoral neck fracture as a prevalent skeletal injury accounts for 7% of orthopedic hospital admission. The aim of the present study is to evaluate the functional outcome of patients with femoral neck fracture treated with total hip arthroplasty (THA) and compare them with those undergoing fixation treatment.
Methods: In this study, we reviewed patients in the age range of 45-60 years old with femoral neck fracture during 2007-2017. The subjects were assigned to either THA or fixation group. The primary outcome was hip function, evaluated with the Harris Hip Scale (HHS). Secondary outcomes included pain, local infection, avascular necrosis (AVN), thromboembolic event, loosening of the prosthetic and internal fixation device, prosthetic dislocation, non-union, and delayed-union.
Results: In this study, 34 patients with displaced fracture of femoral neck were treated with acute THA and 38 patients were treated with fixation. The HHS was higher in the THA group compared to the fixation group (P < 0.050). The results of the present study indicated no significant difference in early postoperative complications over the first month between the two groups, but frequency of complications such as non-union, AVN, pain and loosening of the internal fixation device in the fixation group were significantly higher than the THA group after six months (P < 0.050).
Conclusion: Over a period of six months, THA provided better hip function and significantly fewer postoperative complications compared to fixation.
Background: Dislocation of total hip arthroplasty (THA) needs prompt intervention and reduction either closed or open. It is unusual to left THA dislocated. Hence in this study, the outcomes of neglected prosthesis after THA were determined.
Methods: In this case series study, 15 neglected cases of total hips which had been left unreduced for long time (more than 3 months) were assessed. Cause of postponing reduction, femoral side and acetabular side defects, approach and type of revised prosthesis, Harris hip score (HHS), and other complications were studied.
Results: The results in this study demonstrated that financial issues were the cause of delayed attempt for treatment in 5 cases and the other 10 cases had delay for treatment, because they searched for a specialist to accept performing an operating on them. There were some acetabular side and femoral side defects. By Paprosky classification, in femoral side, there were 6 defects: four type 2, one type 3A, and one 3B. In acetabular side, there were 10 defects (three type 1, one type 2a, three type 2b, one type 3a, and two type 3b). In one developmental dysplasia of the hip (DDH) case, previous osteotomy site was revised (distal segment rotated and then refixed)
Conclusion: Totally, according to the obtained results, it may be concluded that outcomes were relatively good in neglected prosthesis cases after THA. However, recognition of high-risk cases and reduction of delay time may improve the outcomes.
Background: Ochronotic arthropathy is a rare complication in patients with alkaptonuria (AKU) that occurs as a result of ochronotic pigment accumulation in the joints.
Case Report: This case report presents a 54-year-old patient with severe degenerative arthritis who underwent total hip arthroplasty on both sides within an interval of three years. The diagnosis was made by observation of a dark capsule and femoral head during the second surgery. The surgical treatments significantly reduced the pain and improved the range of motion (ROM).
Conclusion: Orthopedic surgeons must be vigilant about clinical manifestations of this rare condition, before and during the surgery. Arthroplasty is a favourable therapeutic option in patients suffering from ochronotic arthropathy.
Multi-Ligament Knee Injury with Concomitant Tibial Tubercle Fracture: A Challenging Case Report and Review of the Pertinent Literature
Background: Multi-ligament knee injury (MLKI) combined with a comminuted tibial tubercle avulsion fracture in the literature has been reported as a very rare condition. To the best of our knowledge, there was no case report of this condition associated with open proximal tibia fractures.
Case Report: A 32-year-old man was referred to our center, with a comminuted tibial tubercle fracture, patella alta, fracture of the tibia at the proximal meta-diaphyseal junction, a Segond fracture, and proximal tibiofibular dislocation on X-ray images. Further assessment of intra-articular pathologies was performed during the operation and complete tear of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) tear were identified. Radial tear of the body and anterior root avulsion of medial meniscus were also noted. All of the extra-articular and intra-articular injuries were addressed surgically, except ACL and PCL tear, which were postponed to a second stage. Proximal tibiofibular dislocation was not approached surgically. The rehabilitation protocol included 6 weeks of non-weight-bearing followed by 6 weeks of crutch-assisted partial weight-bearing ambulation, and forbidden active knee extension during the first 6 weeks and allowing the patient to perform passive flexion of the knee to 90 degrees starting from the second week. Following the rehabilitation program, the patient achieved near-full range of motion (ROM) by the end of 6 months of clinical follow-up.
Conclusion: By means of our specific surgical technique and post-operative rehabilitation protocol, we led the patient with this specific condition to have fracture union and near-normal ROM by the end of 6 months.
The abstract is not available.