Highlights
During the pandemic the number of patients with orthopaedic, and upper extremity problems decreased by 57.09% and 49.77% (p<0.001) compared to 2019.
The turnout of patients with upper extremity & hand-wrist emergencies increased in the private, and significantly decreased in the public sector.
The ratio of upper extremity to total orthopaedic emergencies increased during the pandemic from 37.17% to 43.32% (p=0.006) compared to 2019.
The ratio of hand-wrist to total orthopaedic emergencies increased during the pandemic from 25.07% to 29.15% (p<0.001) compared to 2019.
The increased ratio of hand-wrist to total orthopaedic emergencies reflects the new hobbies uptake and increase of domestic accidents during lockdown.
Introduction Wide awake open carpal tunnel decompression is a procedure performed under local anesthesia. This study aimed to present the effect of various local anesthetics in peri and postoperative analgesia in patients undergoing this procedure.
Materials and Methods A total of 140 patients, with 150 hands involved, underwent carpal tunnel release under local anesthesia. Patients were divided in five groups according to local anesthetic administered: lidocaine 2%, ropivacaine 0.75%, ropivacaine 0.375%, chirocaine 0.5%, and chirocaine 0.25%. Total 400 mg of gabapentin were administered to a subgroup of 10 cases from each group (50 cases totally), 12 hours before surgery. Patients were evaluated immediately, 2 weeks and 2 months after surgery according to VAS pain score, grip strength, and two-point discrimination.
Results In all patients, pain and paresthesia improved significantly postoperatively, while the use of gabapentin did not affect outcomes. Grip strength recovered and exceeded the preoperative value 2 months after surgery, without any difference between the groups. No case of infection, hematoma, or revision surgery was reported.
Conclusion Recovery after open carpal tunnel release appears to be irrelevant of the type of local anesthetic used during the procedure. Solutions of low local anesthetic concentration (lidocaine 2%, ropivacaine 0.375%, and chirocaine 0.25%) provide adequate intraoperative analgesia without affecting the postoperative course.
The introduction of Taylor Spatial Frame (TSF) in clinical practice allows for unique capabilities in long bone deformity corrections; however, a comprehensive understanding of its mechanical characteristics and their impact on callus formation at the osteotomy site is still unclear. The current study is concerned with the clinical application of TSF in high tibial osteotomy (HTO) and the mechanical testing of this device. Fifty-five (55) patients with symptomatic medial compartment knee osteoarthritis and varus deformity underwent open-wedge HTO with the use of TSF and were prospectively monitored with regard to callus formation pattern at the site of osteotomy. Clinical evaluation revealed that the callus formation pattern was eccentric in all patients. In addition, the experimental results from mechanical testing of a clinically relevant TSF configuration indicate, that vertical deflection of the upper bone part during weight-bearing is accompanied by a rotation of the bone axis, which acts in the same direction to the rotation applied during the clinical correction process. The complementary contributions of the deformity correction process and the mechanical response of the TSF under compressive loads, lead to asymmetric gap closure, which promotes the eccentric callus formation in the osteotomy site. The study provides useful information for clinical decision-making regarding callus formation process when TSF external fixator is applied in HTOs.
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