Ultrasound-guided femoral nerve block versus fascia iliaca compartment block for femoral fractures in emergency department: A randomized controlled trial.

Aim: Femoral fractures are one of the most debilitating injuries presenting to the emergency departments (EDs). The pain caused by these fractures is typically managed with opioids and adjunctive regional analgesia. These approaches are often associated with adverse side effects. Thus, appropriate alternative methods should be thoroughly investigated. To evaluate ultrasound-guided femoral nerve block (FNB) with ultrasound-guided fascia iliaca compartment block (FICB) in femoral fractures, to determine which provides better analgesia and less opioid requirement. Methods: This study was a randomized clinical trial performed on adult patients presenting to the ED within 3 h of isolated femoral fracture with initial numerical pain rating scale (NRS-0) score of more than 5. The patients were randomized to receive FNB or FICB. The outcomes were block success rates, pain at 20 (NRS-20) and 60 (NRS-60) min after the end of the procedures, as well as the number and total dose of fentanyl administration during ED stay. Results: Eighty-seven patients were recruited (40 FNB and 47 FICB). Success rates were 82.5% in FNB and 83.0% in FICB group, with no significant difference between the groups. NRS-20, NRS-60, the number of patients who received supplemental fentanyl, and the total dose of administered fentanyl were significantly lower following FNB. However, the length of the procedure was significantly lower in the FICB group. Conclusion: Both FNB and FICB are effective in pain reduction for fractures of femur, but FNB provides more pain relief and less need for supplemental fentanyl.

The Effect of Waterpipe Tobacco Smoking on Bone Healing Following Femoral Fractures in Male Rats.

Background: Given the increasing use of waterpipe tobacco smoking in the world and its unknown effects on bone healing, this study investigated the repairing of femoral bone fractures in rats exposed to waterpipe tobacco smoking (WTS). Main Methods: This study involved 40 male Wistar rats that were divided into two groups, including the femoral fracture (Fx) and the Fx + WTS groups. Each group was divided into two subgroups that were evaluated for bone healing 28 and 42 days after femoral fracture. After fixing the fractured femur, the healing process was evaluated by radiography, pathological indicators, and a measurement of the blood levels of vascular endothelial growth factor (VEGF), parathyroid hormone (PTH), Ca ++, transforming growth factor-beta (TGF-ß), and insulin-like growth factor 1 (IGF-1). Additionally, the density of VEGF and CD34 in fracture tissue was investigated by immunohistochemistry. Key Findings: Radiographic findings showed that factors related to the earlier stages of bone healing had higher scores in the Fx + WTS28 and 42 subgroups in comparison to the Fx groups. The density of VEGF and CD34 showed that the angiogenesis processes were different in the bone fracture area and callus tissue in the Fx +WTS subgroups. The serum levels of VEGF, TGF-ß, and IGF-1 were significantly lower in the Fx +WTS42 group, and PTH in the Fx +WTS28 group was higher than that in the other groups. Significance: The findings showed the disturbance and delay in the femoral fracture union in rats exposed to hookah smoke. This is partly due to the reduction of molecular stimuli of bone synthesis and the attenuation of quantitative angiogenesis.

Preoperative anxiety among Iranian adult patients undergoing elective surgeries in educational hospitals.

BACKGROUND: Although surgical techniques have been improving, preoperative anxiety is still a challenge in preoperative care and is known as an expected response experienced by patients waiting to undergo surgery. The present study aimed to compare preoperative anxiety levels in three educational hospitals in Kerman. MATERIALS AND METHODS: This cross-sectional study was conducted in three educational hospitals in Kerman, Iran, from December 2017 to May 2018. The participants were 100 patients from each hospital (300 patients in sum) who were selected through the convenience sampling method. Sampling was not restricted to sex and type of surgery. The 40-item Spielberger State-Trait Anxiety Inventory was administered to the patients to assess the level of preoperative anxiety experienced by them. Bivariate linear regression models were used to compare the preoperative state anxiety levels based on the patients' demographic information. A multivariate linear regression model was used to determine the predictors of preoperative state anxiety. RESULTS: The participants were 149 males and 151 females with a mean age of 36.38 (12.75) years (age range: 12-79 years). Almost two-third of the patients showed upper-middle symptoms of state anxiety (n = 197, 65.7%) followed by upper-middle symptoms of trait anxiety (40% and 49.3%, respectively). There was a significant relationship between the patient's sex and state anxiety (P = 0.05) and also between trait anxiety and state anxiety (P ≤ 0.001). It was shown that train anxiety could predict state anxiety before surgery (B: 0.53, 95% confidence interval: 0.44, 0.62; P ≤ 0.001). CONCLUSION: The results of the present study confirmed the presence of preoperative anxiety in a sample of Iranian patients. Although the anxiety scores were not very high, organizing intervention and training programs to control and reduce preoperative anxiety among patients seems essential.

Interobserver and intraobserver reliability of different methods of examination for presence of palmaris longus and examination of fifth superficial flexor function.

The palmaris longus is harvested as a tendon graft in various surgical procedures. Several tests are used to assess the presence of palmaris longus tendon. In the present study, we attempted to assess the interobserver and intraobserver reliability of five of the most famous methods and also the examination of fifth superficial flexor function. Two observers, who had been trained on the tests and had practiced them, examined 105 volunteers on two separate occasions and in 1-month interval the results were recorded. The reliability of each method was assessed with Kappa measurement. Kappa ranged from 0.541 (moderate reliability) to 0.813 (almost complete agreement) for palmaris. The highest interobserver and intraobserver reliability and also the best agreement with other tests were of Schaeffer. The lowest kappa was for Thompson and the others have good to excellent reliability. Kappa for interobserver and intraobserver reliability for the fifth flexor were 0.415 and 0.500 (moderate reliability), respectively. The tests that were assessed have good reliability except for Thompson that has a moderate one. It seems that the standard test (Schaeffer) is the best method for the assessment of the absence or presence of palmaris longus. The method used for the evaluation of fifth superficial flexor variations assessment has a moderate interobserver and intraobserver reliability.

Introduction of a New Suture Method in Repair of Peripheral Nerves Injured with a Sharp Mechanism.

BACKGROUND: The standard method for repair of an injured peripheal nerve is epineural repair with separate sutures. Herein we describe a method in which the nerve is sutured with continous sutures. In fact this method has not been utilized for nerve repair previously and our purpose was to compare it to the standard method. If it proved to be successful it would replace the standard method in certain circumstances. METHODS: The proposal of the clinical trial was given a reference number form the ethics comitee. 25 dogs in which the scaitic nerve was cut by a sharp blade under genaeral anesthesia were divided randomly into three groups: control (5 dogs), repair of sciatic nerve with simple sutures (10) and repair with continous sutures (10). In the control group the nerve was not repaired at all. After 6 weeks the dogs were killed and the nerve was studied by light and electronic microscopes. The amount of consumed suture material, time of repair, myelin thickness and axon diiameter were examined. Ultrastructural studies were performed to assess degeneration and regeneration findings. RESULTS: Time of repair and the amount of consumed suture material were significantly lower in the continous group (P<0.001). No difference was found with regard to light microscopy findings and regeneration was confirmed by electron microscopy in the continous group. CONCLUSION: The method described in the present study, provided a result similar to the standard method. Though undobtfully it has some limitations, can replace the standard method in many circumstances.

Prophylactic corticosteroid injection in ulnar wrist pain in distal radius fracture.

BACKGROUND: Ulnar sided wrist pain is one of the most common complications of distal radius fractures. The simplest method for decreasing pain for this affliction is corticosteroid injection. The present study was designed to assess the effect of corticosteroid injection in the prevention of ulnar sided wrist pain. MATERIALS AND METHODS: In this clinical trial patients with distal radius fractures scheduled for closed reduction and percutaneous pin fixation were divided into control and corticosteroid groups. In the corticosteroid group, the patient received a single betamethasone injection in the dorsoulnar side of the wrist before reduction, while the control group received placebo. The patients were to be followed for at least 6 months. RESULTS: 82 patients were followed for 6 months. At the end of the 3 months followup the difference between the two groups about the number of individuals without ulnar sided wrist pain was statistically significant (P = 0.038), so that less patients in the control group were painless, while this was not the case in the 6 months followup (P = 0.507), but in the both time frames the mean grip power, visual analog pain score and the disabilities of the arm, shoulder and hand (DASH) score showed statistically significant difference between the two groups, so that the corticosteroid groups demonstrated greater power grip and less scores in pain and DASH (P < 0.05). CONCLUSION: Based on the findings of the present study it seems that prophylactic corticosteroid injection will be associated with a decrease in the severity of wrist pain in patients with acute distal radius fractures. With regard to the decrease in the number of painless individuals, it seems that the decrease is not persistent. Overall the need for a study with longer followup is obvious.

A Comparison of Glenohumeral Internal and External Range of Motion and Rotation Strength in healthy and Individuals with Recurrent Anterior Instability.

BACKGROUND: The glenohumeral joint becomes dislocated more than any other major joint because it maintains a wide range of motion and its stability is inherently weak. The most common complication following acute initial shoulder dislocation is recurrent dislocation or chronic instability. Imbalance of strength and range of motion in individuals with anterior dislocation can be a contributing factor in recurrent dislocation as well. METHODS: This case-control study consisted of 24 individuals with a mean age of 24.29±4.33 years, and a mean dislocation rate of 5.37±3.62 times. Isometric cuff strength was measured using a handheld dynamometer and for range of motion, the Leighton flexometer was used in internal and external rotational motions of both upper extremities. Independent t-test was used for data analysis. RESULTS: The internal and external range of motion of the injured glenohumeral joint was lower than the uninjured joint (P<0.001). Similarly, the internal and external rotation strength of the injured joint was lower than the uninjured joint (P<0.001). CONCLUSIONS: According to previous data, imbalance of strength and range of motion in individuals with anterior shoulder dislocation can be a contributing factor in long-term disability and increased recurrent dislocation and our finding confirm decreased range of motion and strength in our patients. Hence, proper exercise and rehabilitation plans need to be developed for those suffering from this complication.

Bilateral simultaneous femoral neck and shafts fractures - a case report.

Simultaneous fractures of the femoral neck and shaft are not common injuries, though they cannot be considered rare. Herein, we report our experience with a patient with bilateral occurance of this injury. Up to the best of our knowkedge this is the first case reported in literature in which correct diagnosis was made initially. Both femurs were fixed using broad 4.5 mm dynamic compression plate and both necks were fixed using 6.5 mm cannulated screws. Femur fixation on one side was converted to retrograde nailing because of plate failure. Both neck fractures healed uneventfully. In spite of rarity of concomitant fractures of femoral neck and shaft, this injury must be approached carefully demanding especial attention and careful device selection.