A prospective cohort study was undertaken to observe the long-term outcome of different treatments for palmar wrist ganglia. One hundred and eighty-two patients agreed to participate in the study. One hundred and fifty-five patients (88%) responded at 2 or 5 years. Seventy-nine had been treated by surgical excision, 39 by aspiration and 38 by reassurance alone. At 5 years no significant differences were observed in the recurrence rates which were 42% after excision of a palmar wrist ganglion and 47% (19 of 39) after aspiration. Twenty of the 39 untreated ganglia had disappeared spontaneously. Eighty-five per cent of the patients were satisfied irrespective of treatment. Patients having surgery had a complication rate of 20% and took more time off work (14 days). Significantly more patients in the untreated group felt the persistent ganglion was unsightly. The patient evaluation measure scores were similar. At 2 and 5 year follow-up, regardless of treatment, no difference in symptoms was found, regardless of whether the palmar wrist ganglion was excised, aspirated or left alone. One in four wrists remained weak regardless of treatment or disappearance of the ganglion.

INTRODUCTION Cutiplast (absorbent perforated dressing with adhesive border; Smith & Nephew) is commonly used following orthopaedic operation, but complications of its use have been reported. A prospective, randomised, controlled study was performed to compare the efficacy of Cutiplast versus an Aquacel (hydrofibre dressing; ConvaTec) covered with Tegaderm (vapourpermeable dressing; 3M).PATIENTS AND METHODS Two-hundred patients were randomised to receive one of the two dressings following elective and nonelective surgery of the hip and the knee. We were able to study 183 patients. The condition of the wound and any complications such as skin blistering or signs of infection was noted as was the frequency of dressing changes. RESULTS The Aquacel and Tegaderm dressing was 5.8 times more likely to result in a wound with no complications as compared to a Cutiplast dressing (odds ratio, 5.8; 95% CI 2.8-12.5; P < 0.00001).CONCLUSION Aquacel covered by Tegaderm is a superior dressing to Cutiplast following surgery to the hip and knee.

The aim of this study was to evaluate the effect of a single immediate postoperative instillation of 10 mL of sodium hyaluronate (Viscoseal) into the knee following arthroscopy. A single-center, prospective, randomized, controlled study was undertaken. Consenting knee arthroscopy patients were randomized into two groups following surgery: the study group received 10 mL of sodium hyaluronate intra-articularly, while the control group received an intra-articular instillation of 10 mL of Bupivacaine. Pre- and postoperative visual analogue scale scores for pain and Western Ontario and McMaster Universities (WOMAC) scores for knee function were obtained. Overall, 48 patients under the care of a single surgeon were randomized into two groups of 24. There were no statistically significant demographic differences at baseline. Three patients were lost to follow-up. There was a statistically significant difference in pain scores favoring the study group compared with the control group at 3 and 6 weeks postoperatively (p < 0.05), and a statistically significant difference in WOMAC scores favoring the study group compared with the control group at 3 and 6 weeks postoperatively (p = 0.01). Synovial fluid replacement with sodium hyaluronate following arthroscopic knee surgery conferred statistically significant improvements in pain and function scores compared with Bupivacaine in the short term (3-6 weeks).

Suspected thromboembolic events constitute a major proportion of unplanned referrals back to the hospital. Three deaths due to delayed pulmonary embolism may justify prolonged universal chemoprophylaxis following hip fracture surgery.