The English literature reports a mere handful of cases involving simultaneous dislocation of two joints in the same finger. To our knowledge, all cases reported to date have been in skeletally mature individuals. We report a case of simultaneous proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints dislocations in one finger in a 14-year-old rugby player, managed by closed reduction and early mobilization, with excellent outcome.
Total knee arthroplasty (TKA) is associated with significant postoperative pain. The population receiving TKA is generally elderly and often have multiple comorbidities that can present a challenge to postoperative management. Safe and effective multimodal pain management has led to improved outcomes while minimizing complications and side effects. The objective of this study was to investigate the efficacy of adductor canal blocks (ACB) in patients receiving TKA within a regional Queensland population. We performed a retrospective comparative cohort analysis of 458 patients who received TKA at a regional private hospital between January 2016 and December 2018. Inclusion criteria included body mass index (BMI) <50 kg/m2 and unilateral TKA. Using the patients' hospital records, age, gender, American Society of Anesthesiologists' score (ASA), BMI, diabetic status, length of stay (LOS), opioid requirement on discharge, range of motion (ROM) on discharge, return to theater, and readmission within 12 months were recorded. One hundred and thirty-eight patients received ACB and 263 did not. The two groups were comparable for age, gender, diabetic status, and ASA. Patients who received an ACB had an 18-hour longer LOS (p < 0.0001), but were discharged on lower dosages of opioids equivalent to 7.9 oral morphine milligram equivalent (MME; p < 0.0001). Patients who had an ACB had a similar ROM on discharge and did not have an increased rate of readmission or return to theater. This study demonstrates that ACB are efficacious when used as part of a multimodal analgesia regime for TKA.
AS IN ALL BRANCHES OF MEDICINE, there are continual changes in the field of orthopaedics. Some of the advances are in areas that affect the practice of general orthopaedics, while others may be more specific to subspecialty practice, such as refinements of surgical techniques. Many of the themes are not dissimilar to areas of advancement in other fields. Some advancements worthy of discussion include the development of large databases, a recognition of when surgical management is optimal, adjuvant medications, rapid recovery protocols, peripheral nerve blocks and the increasing use of technology in the operating theatre.
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