ABSTRACT
Background: To conduct a prospective observational study to compare the haemodynamic changes in two age groups, group A: 60-75yrs and group B: >75yrs during cemented bipolar hemiarthroplasty for hip fractures under spinal anaesthesia.Methods: Patients of either sex belonging to above two groups, with no contra-indications for central neuraxial block received spinal anesthesia at lumbar level. Heart Rate (HR), Systolic Blood Pressure(SBP), Diastolic Blood Pressure(DBP) and Mean Arterial Pressure(MAP), pulse pressure variability(PPV), arterial oxygen saturation (SpO2), Electrocardiogram for any changes and nasal end tidal CO2 (EtCO2) were recorded at the following time points: baseline(on table), after giving spinal, after giving surgical position, at the start of surgery, at femoral canal reaming, immediately after cement insertion, every 2 minutes after cement insertion, femoral joint reduction and the end of the surgery. Hypotension, bradycardia, arrythmias, desaturation or unexpected loss of consciousness occurring in peri-cementation period suggestive of ‘Bone cement implantation syndrome’(BCIS) or any other adverse event was recognized and treated.Results: The SBP, HR, PPV, ETCO2, SPO2 and incidence of adverse events; were comparable in both the groups. The difference in the DBP and MAP was statistically significant.Conclusions: The difference in the occurrence of haemodynamic alterations was more in the older age group. Continuous vigilant monitoring during bipolar hemiarthroplasty is required.
ABSTRACT
Reconstruction of degenerated ruptures of the tendoachilles is a challenge. Ruptured tendons and the remaining tendon ends are abnormal. A number of methods have been described in literature reconstruct the tendoachilles, but with variable results1. We used peroneus brevis tendon in 20 patients to augment the repair of degenerated tendoachilles tears by creating a dynamic loop as described by Teuffer et al2. All patients were followed up for atleast 18 months. At the last postoperative visit, 18 out of 20 patients were able to do a toe raise. Eighty-five per cent of patients had excellent or good results and 15% had fair or poor results using modified Rupp scoring. Advantages offered by this procedure are the use of a single incision and mini incision and use of a dispensable tendon such as the peroneus brevis without entirely depending on the damaged tendon for healing.