The Effect of Biomechanical Footwear on Pain from Knee Osteoarthritis

The effect of biomechanical footwear on pain from knee osteoarthritis (OA) is still unclear and controversial. The purpose of this article is to review the literature with the aim of answering the following question: What is the impact of biomechanical footwear on pain from knee OA? A Cochrane Library and PubMed (MEDLINE) search related to the effect of biomechanical footwear on pain from knee OA was performed. Several authors have reported knee pain alleviation in people with knee OA using biomechanical footwear. However, many of them have also stated that further investigation was required to evaluate its long-run effectiveness and safety, as well as replication, prior to reaching conclusions about the clinical value of this treatment. The cost of biomechanical footwear treatment is around 5,000 US dollars. Considering the weak evidence currently available on the efficacy of biomechanical footwear and its high cost, we do not advise the routine use of that treatment until it can be unequivocally confirmed that it is truly effective for pain alleviation in patients with knee OA.

Supracondylar fractures of the humerus in children: treatment by overhead skeletal traction

A total of 120 children with severely displaced supracondylar fractures of the humerus in the absence of neurovascular deficit were treated by overhead skeletal traction. The results were assessed according to Flynn's criteria. After a mean follow-up period of 3.5 years, 68 children (56%) had an excellent result, 40 (34%) had a good result, 4 (3.5%) had a fair result, and 8 (6.5%) had a poor result. Cubitus varus was present in only 4 cases, which compares favorably with the results of operative treatment. The indications for overhead traction and the satisfactory results of this method are discussed.

Injuries of the distal radioulnar joint

Injuries of the distal radioulnar (DRU) joint are common. If the joint is unstable or discongruous, attempts should be made to restore anatomic alignment and stability. Although most acute injuries of the DRU joint are easily treated, they are often overlooked or misdiagnosed because they usually occur in association with other major injuries of the upper limb. Acute and chronic abnormalities are described briefly and the treatment for each is discussed. Appropriate diagnosis and management of the acute injury will yield a much higher success rate than reconstructive procedures to correct a chronic disorder. A differentiation should be made between DRU joint dysfunction and ulnar impingement against the carpus; ulnar shortening is the most commonly used technique to treat the latter condition. In an elderly patient, a Darrach procedure is the preferred treatment for a DRU joint dysfunction; in younger patients, the treatment of choice appears to be resection arthroplasty of the DRU joint with preservation of the ulnar length, the ulnar styloid, and the triangular fibrocartilage complex (TFCC). In cases of malunion of the distal radius with involvement of the DRU joint, the recommended treatment is corrective osteotomy and soft tissue reconstruction of the ligamentous support of the joint.

Proximal tibial valgus osteotomy for hemophilic arthropathy of the knee

Between 1975 and 1985, 14 hemophilic patients with symptomatic genu varum were treated with proximal valgus osteotomies of the proximal tibia; lateral closing wedge tibial osteotomies were carried out; associated fibular osteotomies were not performed, but the proximal tibiofibular syndesmosis was excised in all cases. The mean age of the patients was 32 years, and the average length of follow-up was 6.5 years. Clinical evaluation was undertaken using a modification of the Hospital for Special Surgery Knee Rating Score. Eleven patients (78.5%) had improvements in their postoperative scores, and three patients (21.5%) deteriorated. Postoperative pain decreased in patients who had successful results with no evidence of deterioration over time. There was one case of superficial wound infection, which cleared after the administration of intravenous antibiotics. We conclude that our simplified technique for proximal tibial valgus osteotomy is an effective and reliable treatment method for painful genu varum of the hemophilic knee.

Tranexamic acid is effective in decreasing postoperative intraarticular bleeding in arthroscopic knee surgery

: Arthroscopic knee surgery to perform partial meniscectomy and anterior cruciate ligament (ACL) reconstruction is frequent and effective, although a possible complication is postoperative hemarthrosis. When intraarticular bleeding occurs, in addition to the associated pain, the patient usually requires joint aspiration (arthrocentesis) to avoid loss of range of motion (ROM). Sometimes this complication ends up associated with a poor result of surgery due to a loss of ROM. The aim of this narrative review of the literature is to attempt to clarify whether tranexamic acid (TXA) should be utilized in arthroscopic ACL reconstruction and arthroscopic meniscectomy and by what route (intraarticular or intravenous). A number of studies seem to favor the use of intravenous TXA in patients undergoing ACL reconstruction and arthroscopic synovectomy to diminish articular postoperative bleeding and its consequences (pain, swelling, loss of ROM, and the need for arthrocentesis). Regarding the use of intraarticular TXA, one in-vitro study has indicated that TXA in high concentrations is cytotoxic to chondrocytes. Common sense leads me to conclude that until better designed studies can confirm that intraarticular TXA is not cytotoxic to chondrocytes, its use should not be advised. Currently, for patients undergoing arthroscopic ACL reconstruction and arthroscopic meniscectomy, it seems safer to use intravenous TXA.