Treatment of Acute Scaphoid Fracture by Percutaneus Acutrak Screw Insertion / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to investigate the efficasy of dorsal percutaneous Acutrak screw fixation for acute stable or unstable scaphoid fractures. MATERIALS AND METHODS: We assessed 7 cases of acute scaphoid fracture from January 2001 to Febrary 2002, 5 cases were of acute stable fracture (Herbert type A2) and 2 cases were of unstable minimal displaced fracture (Herbert type B2). All were treated by dorsal percutaneous Acutrak screw fixation. The postoperative management protocol involved removing the splint at postoperative 1 week, this was followed by active and strengthening exercise. Patients returned to work at a postoperative 2 weeks, and a follow-up study 7cases from 12 to 20 months (average 15.8 months). RESULTS: According to tenderness at the anatomical snuff box, pain during range of motion of the wrist joint and the Maudsley scale, 6cases (Herbert type A2: 5 case, Herbert type B2: 1 case) were excellent and one case (Herbert type B2) was good. CONCLUSION: Dorsal percutaneous Acutrak screw fixation is useful method for acute stable or minimal displaced scaphoid waist fractures, because it reduces complications due to prolonged cast immobilization.

Comparison of the Analgesic Effect between Bupivacaine and Morphine by Intra- articular Infiltration after Arthroscopic Knee Surgery

Relief of postoperative pain after arthroscopic knee surgery is important to promote early rehabilitation of patients. This study was aimed to compare the analgesic effects of bupivacaine and morphine injected into the knee after arthroscopic surgery. In a double-blind, randomized trial, we studied 60 patients who received one of three injections at the end of surgery. The patients were randomly divided into three groups; group 1 received 25ml of 0.25% bupivacaine, group 2 received 5mg of morphine mixed with 25ml of 0.9% normal saline and group 3 received a mixture of 25ml of 0.25% bupivacaine and Smg of morphine. Postoperative pain was assessed using a 100-mm visual analog scale(VAS). We recorded the total number of injections of supplemental analgesics, and the occurrence of side effects of bupivacaine and morphine were monitored. In group 1, VAS was significantly lower than group 2 at one and two hours after injection, but it was higher than the other two groups after four hours. In group 2, VAS was significantly lower than group 1 after four hours and later, but it was higher than the other two groups at one and two hours after injection. In group 3, VAS was maintained low during early and late postoperative period. No side effect was found in all patients. We conclude that intra-articular bupivacaine decreases early postoperative pain, morphine decreases late postoperative pain, and the mixture of bupivacaine and morphine is the most effective in controlling the postoperative pain during early and late period.