Device or ice: the effect of consistent cooling using a device compared with intermittent cooling using an ice bag after total knee arthroplasty.

Purpose : To determine the comparative effectiveness of consistent cooling using an icing device (DonJoy Iceman, DJO Canada, Mississauga, ON) versus intermittent cooling using an ice bag (usual care) for the first 48 hours after total knee arthroplasty (TKA). Method : A sample of 78 patients (intervention group, n=37; control group, n=34) undergoing primary TKA were randomized to intervention (device) or control (ice) groups. The primary outcome was pain intensity, measured by numerical pain rating scale (NPRS). Secondary outcomes were passive range of motion (PROM), nausea or vomiting, opioid use, blood loss, lower limb function, hospital length of stay, and patient-reported compliance and satisfaction. Results : No significant differences in the primary outcome (pain intensity measured via NPRS) were observed between control and intervention groups. Patients in the intervention group were significantly more satisfied (8.4 vs. 6.0, p=0.002); used the device more consistently, day and night (85.7% vs. 29.6% and 87.6% vs. 30.8%, respectively, p<0.001); and were more likely to recommend this method of cooling (96.8% vs. 68.0%, p=0.004). Conclusion : The study found no additional benefit of consistent cryotherapy using the icing device over intermittent ice bags on postoperative pain, PROM, nausea or vomiting, opioid use, blood loss, lower limb function, or length of stay, despite significant differences in patient-reported compliance and satisfaction.

Objet: Déterminer l'efficacité comparative du refroidissement constant au moyen d'un dispositif de refroidissement (DonJoy Iceman, DJO Canada, Mississauga, Ontario) en comparaison du refroidissement intermittent découlant de l'utilisation d'un sac à glace (soins habituels) dans les 48 premières heures suivant l'arthroplastie totale du genou. Méthode: Un échantillon de 78 patients (groupe d'intervention n=37; groupe témoin n=34) ayant subi une première arthroplastie totale du genou ont été randomisés dans des groupes d'intervention (dispositif) ou témoin (glace). Le résultat principal était l'intensité de la douleur, mesurée selon une échelle d'évaluation numérique de la douleur. Les résultats secondaires étaient l'amplitude passive du mouvement, les nausées/vomissements, l'utilisation d'opioïde, la perte de sang, la fonction des membres inférieurs, la durée du séjour à l'hôpital, et la conformité et la satisfaction déclarées par les patients. Résultats: On n'a observé aucune différence significative dans le résultat principal (intensité de la douleur mesurée selon une échelle d'évaluation numérique de la douleur) entre les groupes témoin et d'intervention. Les patients du groupe d'intervention étaient considérablement plus satisfaits (8,4 contre 6, 0, p=0,002); utilisaient le dispositif de façon plus uniforme, le jour et la nuit (85.7% contre 29.6% et 87.6% contre 30.8%, respectivement, p<0,001); et étaient plus susceptibles de recommander cette méthode de refroidissement (96,8% contre 68,0%, p=0,004). Conclusion : L'étude n'a révélé aucun avantage supplémentaire découlant de la cryothérapie constante au moyen d'un dispositif de refroidissement par rapport aux sacs à glace intermittents pour ce qui est de la douleur postopératoire, de l'amplitude passive du mouvement, des nausées/vomissements, de l'utilisation d'opioïdes, de la perte de sang, de la fonction des membres inférieurs ou de la durée du séjour, malgré les différences significatives en matière de conformité et de satisfaction déclarées par les patients.

Automated cuff occlusion pressure effect on quality of operative fields in foot and ankle surgery: a randomized prospective study.

BACKGROUND: Limb occlusion pressure, which is present when blood flow ceases, has not had a practical method described for attainment. An automated tourniquet system was modified to set tourniquet pressure based on measurement of limb occlusion pressure (LOP). In this single surgeon randomized prospective study, the effectiveness of this system was assessed on patients undergoing foot and ankle surgery. MATERIALS AND METHODS: Two hundred forty-four patients were randomized to the study group of automated pressure (n = 112) or to the control group (n = 132). The primary outcome measure was tourniquet pressure used for either group. Secondary measures included the time to set the pressure and number of patients failing LOP measurement. The tourniquet field was assessed intraoperatively and postoperatively in a blinded manner. RESULTS: The tourniquet pressure was significantly lower in the study group at 198.5 ± 20.2 mmHg compared to 259.6 ± 4.4 in the control group (p < 0.001). The time to measure the LOP was 20 ± 6 seconds. Six patients failed to be measured. The quality of the surgical field was judged to be better in the study group based on all three methods of assessment. CONCLUSION: LOP measurement was a practical way of setting tourniquet pressures for limb surgery. The automated pressure averages were lower than those routinely used by most surgeons for thigh tourniquets.

A prospective randomized controlled trial comparing circumferential casting and splinting in displaced Colles fractures.

OBJECTIVE: Our primary objective was to determine the effectiveness of 3 immobilization methods (circumferential casting [CC], volar-dorsal splinting [VDS] and modified sugar-tong [MST] splinting) in maintaining the position of displaced distal radius fractures after successful closed reduction. Our secondary objective was to assess longterm functional outcomes associated with immobilization with fibreglass splinting versus standard CC in patients maintaining initial nonoperative reductions. METHODS: We conducted a prospective randomized single-blind controlled trial in patients over 18 years of age who presented to the emergency department with a displaced fracture of the distal radius requiring closed reduction. The primary outcome was loss of reduction (defined as radiologic slippage or the need for surgical fixation during the 3-4 week primary immobilization period after initial successful reduction). Secondary outcomes included DASH (disabilities of the arm, shoulder and hand) score, return to work, activities of daily living, wrist pain, range of motion and grip strength assessed at 8 weeks and 6 months. RESULTS: Thirty participants were randomly assigned to receive MST splinting, 31 to receive VDS and 40 to receive CC. Baseline characteristics were similar among groups. Radiographic loss of reduction occurred in 16% (95% confidence interval [CI] 3.1%-28.9%) of participants in the VDS group, 20% (95% CI 7.6%-32.4%) in the CC group and 30% (95% CI 13.6%-46.4%) in the MST splinting group (p = 0.17). Based on multivariate analysis of variance, functional outcomes at 8 weeks were similar among groups (p = 0.89). DASH scores at 8 weeks and 6 months were similar among groups, based on 1-way analysis of variance (p > 0.25). CONCLUSION: Rates of loss in anatomic position were not statistically significant among the 3 types of dressings used. However, there was a clinically important trend of increased loss of reduction with the use of MST splinting. Functional outcomes at 8 weeks and 6 months were not significantly different between CC, VDS and MDS splinting. Ease of application and familiarity with use should guide clinical decisions when choosing a dressing type for displaced Colles fractures.

Inter- and intraobserver reliability of the COFAS end-stage ankle arthritis classification system.

BACKGROUND: End-stage ankle arthritis should have an appropriate classification to assist surgeons in the management of end-stage ankle arthritis. Outcomes research also requires a classification system to stratify patients appropriately. MATERIALS AND METHODS: Six fellowship trained foot and ankle surgeons met on two occasions to derive a classification system for end-stage ankle arthritis. A four-part classification system was designed. Four surgeons reviewed blinded patient profiles and radiographs on two occasions to determine the inter- and intraobserver reliability. RESULTS: Good interobserver reliability (kappa = 0.62) and intraobserver reproducibility (kappa = 0.72) was demonstrated for the classification system. CONCLUSION: The COFAS classification system appears to be a valid tool for the management and research of end-stage ankle arthritis.