Monteggia fractures in adults

Monteggia fractures are part of a spectrum of forearm injuries and commonly result either from a fall on the outstretched arm with forced pronation or from a direct injury. An understanding of the mechanism of injury and an appropriate clinical examination followed by operative intervention is the basis of present day good practice. This paper reviews the literature and presents a contemporary overview of the Monteggia fracture in adults.

Hip arthroplasty. Part 2: normal and abnormal radiographic findings

This review addresses the normal and abnormal radiographic findings that can be encountered during the follow-up of patients with total hip arthroplasty (THA). The relative significance of different patterns of radiolucency, bone sclerosis, and component position is discussed. The normal or pathological significance of these findings is correlated with design, surface, and fixation of the prosthetic components. It is essential to have a good knowledge of expected and unexpected radiological evolution according to the different types of prostheses. This paper emphasizes the importance of serial studies compared with early postoperative radiographs during follow-up in order to report accurately any sign of prosthetic failure and trigger prompt specialist referral. Basic technical guidelines and schedule recommendations for radiological follow-up are summarized.

The management and treatment of peri-prosthetic fractures around both total hip and hemiarthroplasty

Peri-prosthetic fractures are an increasingly common phenomenon. They are associated with a high mortality, morbidity and economic burden. We reviewed the literature and look at historical aspects, risk factors, clinical assessment, classification and management of peri-prosthetic fractures around the hip. This article is intended to provide an overview to enable safe initial management of peri-prosthetic fractures and insight into definitive treatment.

Hypotensive Resuscitation in Patients with Ruptured Abdominal Aortic Aneurysm

BACKGROUND

The technique of hypotensive resuscitation in haemorrhagic shock involves resuscitation to below normotensive blood pressures achieving the minimum perfusion pressure that will adequately perfuse vital organs until definitive arrest of haemorrhage.

AIM

To summarise the evidence for the use of hypotensive resuscitation in patients with uncontrolled haemorrhagic shock and ruptured abdominal aortic aneurysm (AAA).

METHODS

A MEDLINE (1966-2004) and Cochrane library search for articles relating to hypotensive resuscitation was undertaken; see text for further details.

RESULTS

Several animal studies exist using an abdominal aortotomy model of ruptured AAA. These have demonstrated improved tissue perfusion, decreased blood loss and improved survival associated with hypotensive resuscitation compared with aggressive resuscitation. There are several human studies advocating delayed rather than immediate resuscitation in trauma patients but careful review of the literature reveals no prospective studies of hypotensive resuscitation in patients with ruptured AAA.

CONCLUSIONS

Animal studies demonstrate superiority of hypotensive resuscitation over aggressive resuscitation but further research is required to assess its efficacy in patients with ruptured AAA.

Galeazzi fractures in adults

Galeazzi fractures are not uncommon. They frequently result from falls with forced hyperpronation of the forearm. They are potentially unstable because of certain destabilizing factors at the wrist. Early recognition is essential, as is early operative xation of the radius in adults. This paper reviews the English language literature and current knowledge of Galeazzi fractures in adults.

Differential time scale of fluid and solute permeability following hypothermic lung preservation

BACKGROUND

Assessment of the quality of lung graft preservation by simple functional measures in some laboratory models may fail to detect endothelial injury. The effects of hypothermic preservation in isolation were investigated by measuring the pulmonary capillary filtration coefficient (Kf) and the albumin surface area product (PS) at various cold ischemic intervals.

METHODS

Rat lungs were flushed with University of Wisconsin solution at 4 degrees C. Following storage at 4 degrees C, lungs for Kf measurement were subjected to a change in pulmonary arterial pressure. Kf was calculated from the change in rate of weight gain as a function of hydrostatic stress. PS lungs were exposed to Tris buffered Ringer's solution containing 1125 albumin (20 microM) in an isogravimetric state. Following a vascular flush the lungs were homogenized and underwent scintillation counting. Using the Kedem-Katchalsky equation PS was calculated.

RESULTS

The Kf for the control, 4-hour, and 7-hour groups were 0.778, 1.816, 4.853 g/ cm H2O/min/100 g wet lung tissue, respectively. There was a significant increase in Kf with each time increment (P,0.01). The Kf for the 24-hour group was 5.587 g/cm H2O/min/100 g wet lung tissue; not an additional significant increase. PS for the control and 4-hour groups (0.0115 and 0.0101 cm3/g wet lung tissue/minute, respectively) were not significantly different. After 7 hours there was a significant increase to 0.171 cm3/g wet lung tissue/min. PS could not be measured after 24 hours.

CONCLUSIONS

Significant endothelial injury occurs after 4 hours of cold ischemic preservation. There is progressive injury with time. Increase in water permeability is not secondary to increase in albumin permeability.

Touch allodynia following endoscopic (single portal) or open decompression for carpal tunnel syndrome

We investigated if single-portal endoscopic carpal tunnel decompression equipment (Agee, 3M, USA) would cause increased carpal tunnel pressure during the release and if endoscopic release would reduce postoperative touch allodynia. Measurements on cadavers of the pressure produced during endoscopic release showed similar pressures to those produced during maximal range of motion. One hundred patients underwent either open or endoscopic decompressions. Twenty normal individuals served as controls. At 1 month after surgery both groups had significant allodynia compared with the controls, but at 3 months the endoscopic group had returned to normal though the open group was still significantly abnormal. The reported endoscopic release may therefore be of particular advantage to patients who would seriously be disadvantaged if postoperative touch allodynia should develop. The Agee endoscope is unlikely to cause disturbance of the nerve function due to increased carpal pressure during the release.