Pain Management for Orthopedic Injuries

No-anesthesia for Colles fracture

BACKGROUND

This study aims to measure the perceived pain during the reduction of Colles fracture without anesthesia in both children and adults. It describes the process and reveals duration for reduction, total hospital stays and compares them with the same procedure under hematoma block.

METHODS

We employed the Wong-Baker FACES pain scale to assess pain reduction in 135 adults and 98 pediatric patients undergoing Colles fracture reduction with or without hematoma block. We also measured the time required for the reduction and the overall process.

RESULTS

For fracture reduction without anesthesia, Wong-Baker FACES scores were 9.2 for children and 8.7 for adults. With hematoma block, scores dropped to 7.5 for children and 5.2 for adults with only a 10 min addition to the hospital stay. Pain scores among pediatric patients exhibited moderate to strong negative correlations with age. The reduction maneuver itself took an average of 5 s.

CONCLUSIONS

The reduction of a Colles fracture is nearly instantaneous, making the reduction without anesthesia tolerable. Pediatric patients don't benefit from hematoma block as much as adult counterparts. It significantly reduced pain scores by 1.7 points in children and 3.5 points in adults.

LEVEL OF EVIDENCE

Level I, Randomized Controlled Trial.

Chronic post-traumatic pain: rheumatological and orthopedic aspects

Trauma causes a complex local and systemic reaction of the macroorganism, the consequences of which can be various functional, neurological and psychoemotional disorders. One of the most painful complications of injuries of the musculoskeletal system is chronic post-traumatic pain (CPTP), which occurs, depending on the severity of the damage, in 10–50% of cases. The pathogenesis of this syndrome is multifactorial and includes the development of chronic inflammation, degenerative changes (fibrosis, angiogenesis, heterotopic ossification), pathology of the muscular and nervous systems, neuroplastic changes leading to the development of central sensitization, as well as depression, anxiety and catastrophization. Risk factors for CPTP should be considered the severity of injury, comorbid diseases and conditions (in particular, obesity), stress and serious trauma-related experiences (within the framework of post-traumatic stress disorder), the development of post-traumatic osteoarthritis and chronic tendopathy, genetic predisposition, deficiencies in treatment and rehabilitation in the early period after injury. To date, there is no clear system of prevention and treatment of CPTP. Considering the pathogenesis of this suffering, adequate anesthesia after injury, active anti–inflammatory therapy (including local injections of glucocorticoids), the use of hyaluronic acid, slow-acting symptomatic agents and autologous cellular preparations – platelet-riched plasma, mesenchymal stem cells, etc. are of fundamental importance. However, therapeutic and surgical methods of CPTP control require further study

Injuries to Users of Single-Track Vehicles

INTRODUCTION

Single-track vehicles (including, among others, scooters, bicycles, mopeds, and motorcycles) are becoming increasingly popular means of transport, especially in large cities. A significant disadvantage of single-track vehicles is the low level of protection of users' bodies during road accidents, which causes life-threatening injuries. The aim of this study is to characterize the injuries of users of single-track vehicles.

MATERIAL AND METHODS

An analysis of medical documentation of the ambulance service in the region of central Poland covered cases in 2019-2020. Out of 17,446 interventions, a group of 248 road incidents involving single-track vehicles was selected. The data included the scene of the event, the sociodemographic data of the casualties, the injuries suffered, and the clinical diagnoses. Analyses of the correlation of variables with the chi-squared and Spearman's Rho tests were applied. All results were considered significant at p < 0.05.

RESULTS

In the analyzed period, trips of men accounted for 83.5% of all of the interventions (n = 207), while trips of women accounted for 16.5% (n = 41). The mean age of the victims was 45.66 years (SD ± 20.45). Taking into account the division of single-track vehicles, individual cases were recorded with the participation of bicycles (n = 183), motorcycles (n = 61), and scooters (n = 4). Taking into account the type of event, the following were distinguished: deductions (n = 62), falls (n = 179), and sickness (n = 7). The most common injuries were to the heads of cyclists (n = 101, which constitutes 55.19% of all injuries), lower limb injuries in motorcyclists (n = 35; 57.38%), and head injuries in scooter users (n = 3; 75%). The locations of sustained injuries significantly correlated with the type of vehicle in the cases of head injuries (p = 0.046), spine/back injuries (p = 0.001), pelvis injuries (p = 0.021), and lower limb injuries (p = 0.001).

CONCLUSIONS

The users of single-track vehicles injured in road accidents were more often men than women. The characteristics of the injuries depended on the type of vehicle. The lack of adequate body protection significantly increases the likelihood of death or damage to health. It is advisable to promote safety rules among users of single-track vehicles, with a particular emphasis on the protection of individual parts of the body.

[Control of pain in the early post-traumatic period in the outpatient practice. Results of the multi-center observational study RAPTOR (Rational Analgesia PostTraumatic: an Observational Research)]

AIM

Evaluate the frequency, nature and course of PTP, as well as the effectiveness and safety of NSAIDs in PTP in real clinical practice.

MATERIALS AND METHODS

The assessment of the condition and need for NSAIDs (original meloxicam) in 1115 outpatient patients who suffered a fracture of the radius (32.2%), injury to the knee (35.2%) or ligaments of the ankle (32.6%); women/men 51.5 and 48.5%, average age 46.915.5 years. We evaluated the dynamics of pain intensity (on a numerical rating scale NRS 010) at rest and during movement, the preservation of moderate and severe pain, as well as the development of adverse drugs reactions (ADR) to NSAIDs 48 weeks after injury.

RESULTS

The average intensity of pain during movement decreased from 7.031.66 to 2.211.38 (p0.001), at rest from 4.462.07 to 0.710.989 (p0.001). The number of people with pain severity 4 in the NRS in 48 weeks after the radius fracture, injury of the knee and ligaments of ankle was 21.0, 16.9 and 11.9%, with moderate or severe impairment of the injured limb 40.4, 26.2 and 16.3%, respectively. The need for taking NSAIDs up to 7 days was noted in 43.3%, 714 days-in 41.8%, more than 2 weeks or constantly in 14.9% of patients. Weak or moderate ADR were observed in 20.8% of patients, mainly dyspepsia and hypertension. Discontinuation of NSAIDs due to ADR was required in only 2.6% of patients. Pain retention 4 in NRS was associated with initially expressed pain (7 in NRS) OR 2.75 (95% CI 0.834.13; p0.001) and the presence of osteoarthritis of knee and/or hip OR 1.56 (95% CI 1.032.34; p=0.039).

CONCLUSION

PTP decreases rapidly in most patients after a radius fracture, injury of the knee, and ankle ligament injury while taking the original meloxicam. However, in a significant part of patients, moderate or severe PTP persists after 48 weeks, which requires prolonged analgesic therapy and active rehabilitation.