Anxiety Reaction in Children During Cast Removal using Oscillating Saw versus Cast Shear - A Randomised, Prospective Trial

@#Introduction: To compare the anxiety levels demonstrated by children during cast removal procedure between oscillating saw vs cast shear methods. Material and methods: A randomised prospective study of 102 children (mean age 8.3 ± 3.5 years) with fractures involving upper or lower limbs. Children undergoing removal of cast were divided into 2 groups; either by an oscillating saw or a cast cutting shear. The level of anxiety was assessed by recording the heart rate with a portable fingertip pulse oximeter before, during and after removal of the cast. Objective assessment was performed by documenting the fear level on Children’s Fear Scale (CFS). Results: There was a significant increase in the heart rate of children during cast removal while using the oscillating saw compared to cast shear (p<0.05). The noise level produced by the saw exceeded 80 dB (mean 103.3 dB). The fear level was significantly lower in the cast shear group (p<0.05). Conclusion: The noise produced by the oscillating saw was associated with an increased anxiety level in children undergoing cast removal. Cast shear is a simple and inexpensive instrument that can be used for cast removal in overly anxious children.

Dynamic Hip Screw Compared to Condylar Blade Plate in the Treatment of Unstable Fragility Intertrochanteric Fractures

Dynamic hip screw (DHS) fixation is considered standard treatment for most intertrochanteric fractures. However, excessive sliding at the fracture site and medialisation of femoral shaft may lead in fixation failure. In contrast, fixedangled 95 condylar blade plate (CBP) has no effective dynamic capacity and causes little bone loss compared to DHS. We compared the outcome of 57consecutive unstable intertrochanteric fragility fractures treated with these two fixation methods. CBP instrumentation is more difficult requiring longer incision, operating time and higher surgeonreported operative difficulty. The six month post operative mortality rate is 16%. Post operative Harris hip scores were comparable between the two methods. Limb length shortening more than 20 mm was 6 fold more common with DHS. In elderly patients with unstable intertrochanteric fragility fractures, fixed angled condylar blade plate appears to be a better choice than dynamic hip screws for preventing fixation failures.