ABSTRACT
INTRODUCTION: The study aims to show that total knee arthroplasty using computer-assisted surgical navigation without intramedullary rodding is safer than conventional intramedullary techniques in preventing venous thromboembolism. METHODS: 30 patients were grouped into groups of 10. Groups A and B had conventional intramedullary rodding of the femur and/or tibia. Group C had no rodding of the femur and tibia using computer-assisted surgical navigation. The degree, duration and size of the embolic shower were captured by a transoesophageal echocardiography probe. The echogenic emboli were graded according to the Mayo Clinic score. Haemodynamic parameters such as pulse oximetry oxygen saturation, end-tidal carbon dioxide, heart rate and mean arterial pressure were also recorded. RESULTS: There was a significant difference in the size of the emboli and the Mayo Clinic score when comparing the groups with intramedullary rodding and those without. There was also a significant difference in the pulse oximetry oxygen saturation and heart rate when the group without intramedullary rodding was compared with groups with rodding. CONCLUSION: Surgical navigation total knee arthroplasty may be safer than conventional total knee replacement with intramedullary rodding in preventing venous thromboembolism.
Subject(s)
Arthroplasty, Replacement, Knee/adverse effects , Venous Thromboembolism/etiology , Aged , Arthroplasty, Replacement, Knee/methods , Echocardiography, Transesophageal/methods , Female , Heart Rate , Hemodynamics , Humans , Male , Middle Aged , Oximetry , Oxygen/chemistry , Surgery, Computer-Assisted/methods , Treatment Outcome , Venous Thromboembolism/diagnostic imagingABSTRACT
Hip fractures in nonagenarians represent a special group because of their advanced age and co-morbidities. Surgery is advocated for their younger counterparts but may not appear desirable in nonagenarians. Eighty-four patients were studied over a 2-year period. There were 73 female and 11 male patients. Forty-seven patients sustained an intertrochanteric fracture of the femur. 37 suffered a neck of femur fracture. ASA score of II was the largest group with 51. At least 62 had one co-morbidity or more; 46 were considered demented with a mental test score of less than 7. The mean length of stay was 31 days. Treatment consisted of either traction or surgery. Forty-six patients were managed surgically and 38 non-surgically. Patient review was done 2 years after the fracture. The overall rate of complications was 52% for the operative and non-operative groups. Death outcome at 24 months was not significantly affected by ASA status, number of co-morbidities at admission, or between surgical and non-surgical treatment. However, there was statistical significance between death and the mini-mental test score of less than 7 (P < 0.05). Forty-three patients were still alive after 2 years; of which 27 had been treated surgically and 16 non-surgically. The overall mortality in both operative and non-operative groups is 49%. Surgery significantly increases the ability for independent ambulation (P < 0.01). Therefore the outcome of non-operative and non-operative treatment in nonagenarians with hip fractures is poor due to the high rates of mortality and morbidity.
Subject(s)
Aged, 80 and over , Hip Fractures/therapy , Aged , Aged, 80 and over/statistics & numerical data , Female , Femoral Neck Fractures/mortality , Femoral Neck Fractures/surgery , Femoral Neck Fractures/therapy , Hip Fractures/mortality , Hip Fractures/surgery , Humans , Locomotion/physiology , Male , Orthopedic Procedures/methods , Postoperative Complications/etiology , Psychological Tests , Retrospective Studies , Traction/methods , Treatment OutcomeABSTRACT
INTRODUCTION: This is a report of 2 consecutive cases of the Galeazzi-equivalent fracture in children. CLINICAL PICTURE: In both cases, the mechanism of injury was falls onto the outstretched hand. Radiographs showed fracture of the radius with separation of the distal ulnar physis. TREATMENT: Initial treatment by closed manipulation failed; hence, open reduction and internal fixation was required. The cause of failure of closed manipulation in both cases was interposition of soft tissue into the ulnar fracture site. OUTCOME: Both cases showed good functional outcome after open reduction and internal fixation. CONCLUSION: Recognition of this form of injury is necessary to ensure proper treatment is undertaken to prevent the complications of inadequate reduction and growth retardation.
Subject(s)
Fracture Fixation, Internal/methods , Radius Fractures/surgery , Tendon Injuries , Ulna Fractures/surgery , Wrist Injuries/surgery , Accidental Falls , Adolescent , Bone Wires , Child , Follow-Up Studies , Fracture Healing/physiology , Humans , Male , Radiography , Radius Fractures/complications , Radius Fractures/diagnostic imaging , Range of Motion, Articular , Tendons/surgery , Ulna Fractures/complications , Ulna Fractures/diagnostic imaging , Wrist Injuries/complications , Wrist Injuries/diagnostic imagingABSTRACT
The cord blood glucose-6-phosphate dehydrogenase (G6PD) enzyme activity of 262 normal term Malaysian neonates (92 Malays, 96 Chinese and 74 Indians) was quantitatively determined by the World Health Organisation method. Analysis of variance for the levels of G6PD enzyme activity by ethnic origin and sex showed that there was a significant difference between mean levels of enzyme activity in the three ethnic groups (P = 0.03) but no difference between the sexes (P = 0.36). Multiple range analysis showed that Malays had significantly higher mean levels of G6PD enzyme activity than those of Chinese (P = 0.01). There was no significant difference between the mean levels of G6PD enzyme activity of Chinese and Indians (P = 0.52), nor was there any difference between those of Malays and Indians (P = 0.08). The difference in levels of G6PD enzyme activity among the different ethnic groups could be due to the existence of different G6PD variants.
