RESUMO
Scaphoid fractures are the most common fractures of the wrist. This study compared the outcomes of two surgical internal fixation techniques, using either Herbert screws [HS group] or multiple pins [MP group], in the treatment of scaphoid fractures. This cross-sectional study was performed on 41 patients [23 in HS and 18 in MP groups] with unilateral scaphoid fractures from September 2009 to September 2011. All patients were followed-up two weeks post-surgery, every month for six months, and then every year after one year. Degree of fracture healing, measured level of pain using Visual Analog Scale [VAS], range of motion, hand grip strength of affected limb vs. healthy limb, Quick DASH score [QD] and also Mayo Modified Wrist Score [MMWS] were recorded. In December 2012, all patients presented to the Orthopedic Clinic for their final follow-up visit where all data was recorded once more. Mean patient follow-up time was 24.34 +/- 8.70 months [range: 11-34]. Mean scaphoid fracture healing times for the HS and MP group were 14.61 +/- 3.88 and 14.39 +/- 4.27 weeks, respectively. No statistically significant difference was found between both groups after comparing mean levels of pain using VAS, ROM of wrist during flexion and extension, hand grip strength expressed as percentage of normal, QD, and MMWS. The level of patients' content using VAS was 9.5 for HS and 9.0 for MP groups. The use of multiple pins for the internal fixation of scaphoid fractures proves to be a viable treatment option compared to Herbert Screws, due to decreased cost and increased availability
RESUMO
Acute pain is common after arthroscopic surgeries and it is one of the most important causes of patient dissatisfaction, admission time and increased morbidity, Gabapentin with anti-hyperalgesic effects can play a critical role in pre-emptive analgesia methods. The aim of this study was to assess the efficacy of gabapentin in pain management after surgery and the rate of drug consumption in patients who are candidate for anterior cruciate ligament [ACL] reconstruction arthroscopic surgery. In this randomized, triple blind clinical trial, 114 patients who were candidate for arthroscopic ACL reconstruction were divided into two groups of gabapentin [G] and placebo [p], with 57 patients in each group. The intervention group received gabapentin 600 mg and a placebo was administered in control group. Patients received on-demand pethedine for pain management. The primary outcome was pain intensity according to the visual analogue scale [VAS] and the secondary outcome was the amount of opioid consumption and incidence of side effects [including: dizziness, sedation, nausea and vomiting] at 6 and 24 h visits. The mean pain intensity in G group at both the 6 and 24 hour visits was significantly lower than the control group [Both p<0.0001]. Also, patients in the gabapentin group consumed less opioid at both visits in comparison to the placebo group [p<0.001, p=0.032]. The incidence rate of sedation, dizziness, nausea and vomiting was similar in both groups. In arthroscopic ACL reconstruction, administering a preoperative single dose of 600mg gabapentin may decrease both pain intensity and opioid consumption