Total knee arthroplasty (TKA) patients express minimal comfort regarding postoperative pain management. The use of parenteral opioids or epidural analgesia may have unfavorable adverse impacts that interfere with quick healing and rehabilitation. It is uncertain if periarticular multimodal drug injections (PMDI) are effective at easing pain following total knee or total hip arthroplasty (THA). We conducted this study to assess the effectiveness of PMDI following TKA or THA. Articles were sourced using the following keywords on Pubmed, Google scholar, and the Web of Science: multimodal drug cocktail in total knee arthroplasty OR hip arthroplasty, periarticular injections AND multimodal drug cocktail, epidural versus periarticular injections AND pain management after total joint arthroplasty. After screening 438 articles and abstracts, 200 pertinent studies were found, of which a total of 10 articles were included in the study. From this review, we want to conclude that despite the various ways to address postoperative pain, there is no acknowledged gold standard for postoperative pain management following total joint arthroplasty. To reduce narcotic intake and prevent narcotic-related adverse reactions, multimodal techniques utilizing regional anesthetics appear to be on the rise such as periarticular injections, or patient-controlled analgesia with or without femoral nerve block. Even though the ideal duration and kind of medications are unclear, preoperative pain management or preemptive analgesia with anti-inflammatory drugs and opioid analgesics seem to be useful in lowering postoperative pain.
Giant cell tumour of the tendon sheath (GCTTS) is a rare benign soft tissue tumour with no known cause. It is more prevalent in the hand than in the ankle and foot. It appears as a non-painful, perceptible enlargement. Although pre-operative imaging and fine-needle aspiration cytology (FNAC) corroborate suspicion, histology following surgical resection is used to confirm the diagnosis. Due to its rarity, a case of giant cell tumour (GCT) of the extensor tendon sheath of the left ring finger is reported here. A 39-year-old female presented with a six-month history of painless swelling over left ring finger. The swelling was spontaneous, slowly progressive and painless. On clinical examination, a 1.5 cm x 1 cm firm swelling was seen on the dorsal surface of the left ring finger extending from the distal portion of the middle phalanx to the proximal half of the distal phalanx. The swelling was well-defined, smooth, firm, and uniform in consistency. The swelling was movable sideways with no attachment to the bone when examined clinically. X-ray of the hand showed soft tissue mass without the involvement of the bone. Soft tissue mass was seen on ultrasonography. An excisional biopsy was done. Histopathology showed typical features of GCTTS. Our case is a rare example of GCTTS in a single digit of the hand. Furthermore, considering its high recurrence risk, the tumour should be totally excised. Finally, if required, the hand's function should be recreated to minimise the loss.
BackgroundThe most frequent upper limb fractures are distal end radius fractures, accounting for around 17% of all fractures in clinical practice. Falling on an outstretched hand is the most common mechanism of injury, and it can also occur in high-energy trauma in young individuals. A minimally invasive technique of percutaneous pinning was introduced to sustain the fracture's reduction after manipulation and avoid the re-displacement of fractured fragments. Antegrade intramedullary K-wire fixation is a cost-efficient procedure that can be done in rural settings. MethodologyA total of 30 patients with fractures of the distal end radius managed with antegrade intramedullary K-wire fixation were included in the study. Operated patients were followed up at one month, three months, and six months for functional assessment. An X-ray was taken on every follow-up to assess the union and implant positioning. ResultsIn our study, the mean age was 45.6 years. Out of the 30 patients, 12 were males and 18 were females. All 30 patients at the final follow-up showed good functional improvement, with statistically significant improvements in palmar flexion, adduction and abduction, and pain scale scores. ConclusionsAntegrade K-wire fixation is an effective technique for fractures of the distal end radius that can be performed in rural settings with effective results.
Bicondylar tibia plateau fractures are a common injury in day-to-day practice, and categorization and treatment methods have been effectively described in the literature. The Hyperextension bicondylar tibia plateau (HEBTP) fracture is an uncommon fracture that is difficult to classify using standard classification techniques and has no set treatment strategy. Compressed anterior cortex, tension stress failure of the posterior cortex and loss of normal posterior slope of tibia plateau are all symptoms of HEBTP, which is produced by hyperextended high-energy trauma. HEBTP fracture is a kind of tibia plateau fracture which largely affects the tibial condyle' sagittal alignment. They account for fewer than 20% of all bicondylar injuries. As the knee has varus alignment and restraint of the knee's posterolateral capsule-ligamentous complex, there is asymmetric accumulation of force to the medial plateau resulting in a characteristic injury pattern that is often more severe on this side. Hence, we discuss a case of HEBTP managed with bicondylar plate and its functional outcomes. We present a case of a 44-year-old male patient who came to Acharya Vinoba Bhave Rural Hospital, Wardha with 5-day-old history of high-energy trauma to the right knee, with discomfort and swelling over the right knee and inability to bear weight over the right lower limb. The patient initially went to a local doctor and was treated conservatively with an above knee slab over his right lower limb before being sent to AVBRH for further treatment. On examination, there was extensive edema and varus deformity over the right proximal tibia. The tibia had substantial posterior sag, which is unusual in a tibial plateau fracture. Tenderness was present across the proximal one-third of the tibia, although there was no increase in local temperature. Range of motion in the knees was not possible. Clinically, there was a 10° varus deformity. The posterolateral ligament complex and collateral ligaments could not be evaluated. There were no symptoms of compartment syndrome present. There was no neurovascular injury. Distal circulation was intact. The differential diagnosis was posterolateral corner injury, posterior subluxation, or dislocation of the knee. To rule out the differentials, radiological imaging, X-ray, and a computed tomography scan were performed and the patient was diagnosed to have hyperextended bicondylar tibia plateau fracture. Open reduction and internal fixation with bicondylar plate osteosynthesis were used to treat the patient and extensive postoperative physiotherapy regimen was started. The patient was then followed up and results were recorded. The treatment for hyperextension tibia plateau fractures includes reducing fractures while healing critical ligament damage and restoring knee joint stability. If the tibial rim is depressed, the tibial rim should be rebuilt to restore the joint's stability. The features of anterior tibia fractures produced by knee hyperextension injuries are unknown at this time. For anterior tibia plateau fractures, there is very less unanimity on the best technique and fixing methods. The clinical dilemma of deciding how to decrease as well as cure the fractures of the anterior tibia plateau produced by the hyperextension injury remains unsolved. The treatment of hyperextension bicondylar tibia plateau fractures managed with open reduction and bicondylar plate osteosynthesis yields outstanding outcomes.
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