Treatment of tibial shaft fractures with Kuntscher nail without opening fracture cavity in condition of without C-ARM in Da Nang General Hospital

Background: Leg bone fracture is common seen in orthopedic trauma. Currently, the trend of treatment is using a less invasive technique. Especially, with application of C-Arm in surgery, closed Kuntscher nailing technique has made the treatment of leg bone fractures achieving more new improvements. Objectives: To summarize the experiences in the technical implementation process and to assess results of treatment. Subjects and method: A descriptive, retrospective study was conducted on 112 patients was confirmed diagnosed with leg bone fractures (81 males, 31 females, the average aged 29\xb15.3), were operated in Da Nang General Hospital from January, 2004 to June, 2006. All of them were performed with Kuntscher intramedullary nail in tibia without opening fracture cavity, in condition of without C-Arm. Results: The patients with combined injuries included 5 cases of 2 legs fracture, 2 cases of hip fracture, 5 cases of leg fracture in 2 stages, 1 case of collabone fracture. Postoperative observations: no case of infection, patients were discharged after 2-7 days, the average length of hospitalization was 3\xb12.4 days. Complication: 1 case of secondary deviation, no case of any delay to heal bone, broken nails. Recording a case of nail was rise up to cause painfully and synovial capsule inflammation of knee joint. Conclusion: The implementation of this less invasive technique should be orderly done. The most ideal indication was tibial shaft fractures in stage of middle 1/3. Because of a minimally invasive technique so patients were less painful, fracture healing quickly, early mobilization could be set, surrounding joints were not affected.

Comparison between combination of marcaine and fentanyl with marcaine alone during epidural block for lumbar discectomy

A prospective study involved 64 patients (43 men, 21 women) aged from 20 to 62 years with lumbar disc herniation who had operated at Military Hospital 103. These patients were divided into 2 groups. Group 1 received marcaine (0.25%-0.375%) plus fentanyl, group 2 received marcaine (0.35% - 0.5%) alone for lumbar epidural anesthesia. The volume of local anesthetic solutions injected epidurally was calculated based on number of segments that had to block, with dose of 1.5 - 1.6 ml per segment. The results showed that compare with marcaine alone, the combination of marcaine and fentanyl provided better analgesic effect, faster onset and longer duration of action, caused milder hemodynamic changes, decreased the incidence of adverse effects and produced satisfactory post-operative condition

Effect of marcaine with fentanyl combination on epidural anesthesia for lumbar disc herniation surgery

Effect of marcaine plus fentanyl combination for lumbar epidural anesthesia was investigated in random series of 33 patients who were undergoing lumbar discectomy. Patients received 1mg/kg marcaine with 1mcg/kg fentanyl. The volume of local anesthetic solution was calculated basing on the number of segments that needed to block: 1.5 - 1.6ml per segment. It was found that the marcaine plus fentanyl combination provided high effect (100%) on epidural anesthesia, rapid onset (7.51.8 min), long working duration (33070 min), caused milder hemodynamic changes, decreased the incidence of adverse events and produced satisfactory operating condition.