Low- vs. high-pressure suction drainage after total knee arthroplasty: a double-blind randomized controlled trial.

AIM: The aim of this study was to assess the efficacy of continuous low-pressure suction drainage compared with closed high-pressure suction following total knee arthroplasty. BACKGROUND: Closed wound drainage systems are used in surgical interventions to reduce the incidence of haematomas, promote wound healing and reduce infections. However, evidence shows that using a closed wound drainage system can increase transfusion requirements. DATA SOURCES: A randomized, double-blind and parallel controlled trial was performed. Adult knee replacement patients recruited between May 2006 and March 2007 were assigned to receive low-pressure suction of 50 mmHg (experimental drainage) or high-pressure suction of 700 mmHg (comparator drainage). METHODS: The primary outcome was total blood loss after surgery. Secondary outcomes were incidence of transfusion, complications and mortality. Statistical analysis was based on an intention-to-treat approach. Linear regression was performed to account for factors that could influence blood loss. RESULTS: A total of 169 patients were included. Mean age was 73 (±6) years, 128 women and 41 men. A total of 84 patients were randomized to the experimental drainage and 85 to the comparator drainage. Analysis showed a total postoperative blood loss of 541·8 mL in the experimental group and 524·4 mL in the comparator group (P = 0·734). The only factor that showed an association with blood loss was the length of surgery. Linear regression did not show differences between the groups. CONCLUSION: Continuous low-pressure suction of 50 mmHg is not more effective than the higher aspiration pressure system to diminish the blood loss in total knee arthroplasty. The results do not support any change in current nursing practice relating to the use of this drain system.

Distal radioulnar joint prosthesis for the treatment of giant cell tumor of the distal ulna: a case report and literature review.

Giant cell tumor (GCT) of the distal end of the ulna is an uncommon site for primary bone tumors. When it occurs, en-bloc resection of the distal part of the ulna with or without reconstruction stabilization of the ulnar stump is the recommended treatment. We present a case of a 56-year-old man with a GCT of the distal ulna treated successfully with an en-bloc resection of the distal ulna with reconstruction using radioulnar joint prosthesis. Although the experience with this type of treatment is limited, implantation of a metallic prosthesis to replace the distal part of the ulna can also be considered as a salvage procedure for the treatment of this difficult pathology.

Idiopathic transient osteoporosis of the pelvis in a non-pregnant young woman: a case study.

Idiopathic transient osteoporosis of the hip is a rare condition that was first described in a series women in their third trimester of pregnancy. The clinical course is usually benign and self-limiting. Magnetic resonance is very useful for the diagnosis. Differential diagnoses include avascular necrosis of the femoral head, septic arthritis of the hip, osteomyelitis, stress fractures, primary or secondary neoplastic processes, and referred pain from the spine or genitourinary tract in pregnant women. The authors present a case of idiopathic transient osteoporosis of the pelvis in a young nonpregnant woman with insidious hip pain with no antecedent infection or trauma.

The spacer block technique in osteomyelitis of the phalangeal bones of the hand.

The authors report a case of an open mallet injury with a traumatic arthrotomy which was complicated with a destructive infection involving both the middle and distal phalanges of a ring digit and which was treated with two-stage reconstructive surgery with good results. In the first stage, after the osteomyelitic portion of adjacent phalangeal bones were excised en bloc, the dead space was filled by means of an antibiotic-impregnated cement spacer. In the second stage, an autogenous corticocancellous bone graft from the iliac crest was secured into the defect with a intramedullary Herbert scaphoid screw.