The study is a prospective blinded randomised controlled trial to compare the efficacy of triamcinolone acetonide, bupivacaine or in combination in managing pain after lumbar discectomy. Patients undergoing primary single-level lumbar discectomy were randomised. Triamcinolone acetonide, bupivacaine or in combination was instilled at the nerve root as decompression. Preoperative, day 1 and 6 weeks pain score, 24-h postoperative opiate requirements and duration of inpatient stay were recorded. Data was analysed using Mann-Whitney test for statistical significance. 100 patients were recruited. A significant difference was noted in day one postoperative mean pain score, mean 24-h opiate requirement and mean inpatient stay in the triamcinolone acetonide and bupivacaine group. At 8 weeks postoperatively, no significant differences were seen in the pain score in all groups. Significant postoperative pain reduction and opiate requirements in the first 24 h, and significantly shortened duration of inpatient stay were achieved in the triamcinolone acetonide and bupivacaine group compared with other groups.
Synovial chondromatosis is an uncommon condition affecting large joints such as hip, knee, shoulder and elbow. Diagnosis can be achieved by history, examination and radiographic findings. Histological diagnosis is definitive. A 53 year old female patient presented with 2 months history of ankle injury and was treated as ankle sprain. A diagnosis of monoarticular synovial chondromatosis affecting the subtalar joint with extra articular involvement was made and treated with excision of lesion with satisfactory outcome at one-year review. We found 4 cases of subtalar synovial chondromatosis in the English literature but no history of trauma documented their presenting compliant. The injury had prompted the investigation, treatment and may contribute to the satisfactory outcome as the condition was treated at an earlier stage.
Chronic neglected subtalar dislocation associated with a non-union talar neck fracture is rare and never documented before. The lack of information from the literature on the optimal management prompted us to describe our experience in the management of this condition. We reported a case of a 57-year-old women presented with this injury. A satisfactory outcome was obtained using a tibio-talo-calcaneal arthrodesis through a plantar approach.
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