Intra-articular drain versus no drain after arthroscopic anterior cruciate ligament reconstruction: a randomized prospective clinical trial

A significant proportion of surgeons use intra-articular drains after arthroscopic anterior cruciate ligament [ACL] reconstruction. Recent studies have not encouraged the routine use of postoperative drain after arthroscopic surgery. The aim of this study is to assess the validity of intra-articular drain use after arthroscopic anterior cruciate ligament reconstruction. Orthopedic Department, Salmaniya Medical Complex. A prospective randomized study. In this study, forty consecutive arthroscopic ACL reconstruction patients were randomized alternately for either intra-articular suction drain group or non-drain group. All arthroscopic ACL reconstructions using a four strands hamstrings graft as auto graft were included in the trial. The outcome was evaluated in the first three days, first week, fourth week and eighth week. The results were evaluated through pain assessment, range of motion [ROM], and grade of haemoarthrosis. The two groups were comparable in surgical findings and procedures performed. In the first three days, the non-drain group used nearly double the amount of analgesia compared to the drain group. The grade of hemarthrosis was less by one grade in drain group than in non-drain group according to Coupen and Yates grading[1]. However, there were no differences in pain and range of movement at week four or eight. During the study period, there were no complications in either group. This study showed that pain and hemarthrosis are less in the drain group than the non-drain group. The range of movements is better in the drain group than the non-drain group in the first week

Humeral head osteonecrosis in sickle cell disease

Sickle cell disease is the commonest cause of humeral head osteonecrosis worldwide. 144 shoulders in 72 patients with sickle cell disease were assessed clinically and radiographically. Our null hypothesis is that there is no correlation between the shoulder symptoms and the radiographic extent of osteonecrosis in such patients. The symptoms of each shoulder were scored using the UCLA shoulder scoring system. All shoulder x-rays were staged for humeral head osteonecrosis according to the modified Ficat and Arlet staging system. The Wilcoxin ranked sum test was used to correlate the data of the UCLA score with the data of the modified Ficat and Arlet stage. This gave a coefficient of 0.189. It is concluded that there is most likely no correlation between the shoulder symptoms and the radiographic stage of humeral head osteonecrosis in patients with sickle cell disease

Constant shoulder score following scapulectomy

The indications and techniques of scapulectomy have been well described in the literature but little has been reported on the objective functional outcome. We present a series of 4 patients who had total or subtotal scapulectomy for neoplasms of the scapula. The shoulder function was evaluated using the Constant Functional Scoring system. Three of 4 patients scored excellent with no impairment of daily living activities. Preservation of the glenoid was associated with best results. The use of Constant shoulder score is a valuable tool in assessing the functional outcome following scapulectomy

Isolated rupture of the subscapularis Fenton

Isolated rupture of the subscapularis tendon is an uncommon injury. This can be caused by violent external rotation of the adducted arm. We report such a case that underwent surgical repair. The operative technique is described

Role of splenectomy in splenic disorder

To study the haemoglobinopathies with their subsequent splenomegalic and hypersplenic symptoms and to assess the postoperative complications of splenectomy. There were 50 patients with splenic pathology operated upon in the Salmaniya Medical Centre. The symptomatology of splenomegaly and hypersplenism were evaluated in addition to the surgical indications for splenectomy; specific reference was made to splenic weight, its relation to morbidity and mortality and especially the occurrence of post-splenectomy sepsis. Haemoglobinopathies with their consequent splenomegalic and hypersplenic symptoms are a common indication for splenectomy in this part of the Arabian Gulf. Several studies have cautioned about post-splenectomy complications. The aim of this study was to assess these complications with specific reference to post-splenectomy sepsis and also to verify any relation between such complications and splenic size. Splenectomy was performed for splenomegaly and hypersplenism in 19 [38%] of the 50 patients; 17 [34%] had splenectomy because of splenic trauma and the remaining 14 [28%] because of lymphomas and/or adjuvant to other surgical procedures. The spleen weight was 840 g [range 185-2200 g]. The largest and heaviest spleens were found in patients with splenomegaly, and hypersplenism with sickle-cell disease. The mortality rate was 4% and postoperative complications were observed in 16%. There was no relation between the complication and splenic size. Our results show that these patients benefited from splenectomy, in terms of life-saving, haematological improvement and relief of discomfort and pain. These results were achieved with an acceptable mortality and morbidity