Radiological radio-carpal and mid-carpal motion after operative treatment of dorsal radio-carpal fracture dislocations.

PURPOSE: Radio-carpal fracture dislocations are rare severe injuries typically seen following high energy trauma. This injury is characterized by complete dislocation of the radio-carpal joint with avulsion fracture of dorsal or palmar cortical rim of the distal radius combined with disruption of the radio-carpal ligament complex. The purpose of our study is to assess the radiological motion outcome of the radio-carpal joint after Moneim type 1 radio-carpal fracture dislocations following surgical treatment. PATIENTS AND METHODS: Only Moneim type 1 injuries were included in this study. Eight patients with Moneim type 1 injuries were identified by retrospective examination of our fracture registry and included in this study. All patients were initially treated with closed reduction and plaster immobilization. CT scans were performed after reduction. Operative treatment consisted of anatomic reduction of the distal radial rim fractures and fixation with a small T-plate through a dorsal approach. Cancellous bone graft was utilized if necessary to support the articular surface. Repair of the palmar radio-carpal ligament complex was performed through a palmar wrist approach. Antero-posterior, lateral, as well as lateral flexion and extension radiographs were taken at an average follow-up of 4.1 years. RESULTS: Follow-up radiologic evaluation of standard lateral radiograph revealed a mean scapholunate angle of 55.6°. The mean capitolunate angle was found to be −11.6° and the mean radio-capitate angle was 10.5°. The average noted angles in maximum flexion were as follows: radiolunate 15.3°, capitolunate 18° and radiocapitate 30°. The average angles in maximum extension were: radiolunate −23.9°, capitolunate −31° and radiocapitate −55°. At follow-up, arthritic changes were assessed radiographically using the classification described by Knirk and Jupiter. Fifty-six percent of the patients were found to exhibit stage 1 traumatic arthritis, 33% had stage 2 traumatic arthritis and 11% exhibited stage 3 traumatic arthritis with radio-carpal joint space obliteration. CONCLUSION: Rigid bony fixation and palmar radio-carpal ligament repair of Moneim Type 1 radio-carpal dislocations resulted in preservation of sagittal plane motion of the proximal carpal row in eight of nine cases. Our data suggest that surgical reconstruction of Moneim type 1 injuries is the preferred treatment and usually leads to satisfactory range of motion.

Management of temporary urinary retention after arthroscopic knee surgery in low-dose spinal anesthesia: development of a simple algorithm.

INTRODUCTION: In practice, trauma and orthopedic surgery during spinal anesthesia are often performed with routine urethral catheterization of the bladder to prevent an overdistention of the bladder. However, use of a catheter has inherent risks. Ultrasound examination of the bladder (Bladderscan) can precisely determine the bladder volume. Thus, the aim of this study was to identify parameters indicative of urinary retention after low-dose spinal anesthesia and to develop a simple algorithm for patient care. MATERIALS AND METHODS: This prospective pilot study approved by the Ethics Committee enrolled 45 patients after obtaining their written informed consent. Patients who underwent arthroscopic knee surgery received low-dose spinal anesthesia with 1.4 ml 0.5% bupivacaine at level L3/L4. Bladder volume was measured by urinary bladder scanning at baseline, at the end of surgery and up to 4 h later. The incidence of spontaneous urination versus catheterization was assessed and the relative risk for catheterization was calculated. Mann-Whitney test, chi(2) test with Fischer Exact test and the relative odds ratio were performed as appropriate. *P < 0.05. RESULTS: Seventy percent of the patients were able to void spontaneously; in 30%, a Foley catheter had to be inserted because bladder volume exceeded 500 ml and/or urination was insufficient (P < 0.01). Bladder volume differed independently of the fluid infused. Additionally, patients with a bladder volume >300 ml postoperatively had a 6.5-fold greater likelihood for urinary retention. CONCLUSION: In the management of patients with short-lasting spinal anesthesia for arthroscopic knee surgery we recommend monitoring bladder volume by Bladderscan instead of routine catheterization. Anesthesiologists or nurses under protocol should assess bladder volume preoperatively and at the end of surgery. If bladder volume is >300 ml, catheterization should be performed in the OR. Patients with a bladder volume of <300 ml at the end of surgery may be transferred to the ward or recovery room. In these patients, bladder volume must be checked at least every 60 min for a maximum of 3 h or until spontaneous voiding is possible or bladder volume is >500 ml.

Gemcitabine with cyclosporine or with tacrolimus exerts a synergistic effect and induces tolerance in the rat.

BACKGROUND: This study investigated the effect of the antineoplastic agent gemcitabine (dFdC) in combination with cyclosporine (CsA) or with FK506 on acute heart allograft rejection in a rat model. METHODS: Transplantations were performed in the fully allogeneic Lewis-to-Brown Norway strain combination. dFdC, CsA, and FK506 single-drug therapy and combinations of dFdC with CsA and FK506 were administered at various dosages starting on day 1 to prevent and on day 4 to treat acute rejection until day 20. Animals who did not reject their graft were intraperitoneally injected with 108 splenic donor-type lymphocytes. In addition, Lewis and third-party skin grafts were transplanted to these animals. RESULTS: Mean graft survival times under CsA, FK506, and dFdC monotherapy were 18.3/63.7 days (1 mg/5 mg per kg), 41.7 days, and 24.7/38.7 days (100 microg/150 microg per kg), respectively. CsA and FK506 in combination with dFdC prolonged graft survival to more than 100 days (CsA) and more than 95.2 days (FK506). Graft survival after treatment of an ongoing rejection was 21.5/38.3 days for CsA (1 mg/5 mg per kg) and 17.7/59.2 days for dFdC (100 microg/150 microg per kg). The combination of CsA+dFdC prompted indefinite survival of five of six hearts. Lymphocyte inoculation did not induce graft rejection. Notably, none of the Lewis, but all third-party, skin grafts were rejected immediately. Histomorphologic analysis of grafted hearts, however, demonstrated typical features of chronic rejection. CONCLUSIONS: The combination of CsA and FK506 with low-dose dFdC exerts a synergistic effect in the prevention and treatment of acute allograft rejection in this model. Although chronic rejection could not be prevented, strain-specific tolerance was achieved. Therefore, combining standard immunosuppressants with dFdC is a novel, promising strategy for prevention and treatment of acute allograft rejection.