Management of knee arthroscopy portals.

Although the use of suture material for closure of knee arthroscopy portals has decreased, many surgeons continue to use adhesive tape, assuming this is superior to leaving them open. We have investigated two modalities of portal management after knee arthroscopy, the open method and the use of adhesive tape, documenting wound healing, complications and patient satisfaction. Eighty-seven patients (92 knees) were included in this study, 183 portals were involved. Sixty portals (30 knees) were closed with adhesive tape and 123 portals (62 knees) were left open. Follow up was at 2 weeks and at a further 6 weeks post operatively for those with a complication. In the adhesive tape group there were 6 portals with a complication (10%). In the open group there were 13 portals with a complication (10.56%). There were no major or long term complications and no significant difference between the two methods of treatment (P = 0.908 for portals, P = 0.954 for knees). We concluded that leaving knee athroscopy wounds open is an acceptable method of management when compared to adhesive tape.

Melatonin reduces quinolinic acid-induced lipid peroxidation in rat brain homogenate.

The protective effects of melatonin against the neurotoxin, quinolinic acid, were investigated in rat brain homogenate using the thiobarbituric acid assay. Quinolinic acid increased lipid peroxidation in a dose dependent manner. When homogenate was cotreated with melatonin there was a significant decrease in lipid peroxidation. The results of the present report show that melatonin may play a protective role in the brain against the neurohormone quinolinic acid, which has been identified as a causative agent in Huntington's Disease.

Melatonin plays a protective role in quinolinic acid-induced neurotoxicity in the rat hippocampus.

The neuroprotective effect of melatonin against the quinolinic acid-induced degeneration of rat hippocampal neurons was investigated. Three groups of rats were given intrahippocampal injections of either; saline, quinolinic acid or i.p. injections of melatonin prior to and after being injected with quinolinic acid. On the fifth day after the intrahippocampal injections the brains were removed and the hippocampi either sectioned and stained for microscopic examination or used in glutamate receptor binding studies. The results show that melatonin protects hippocampal neurons from quinolinic acid-induced neurodegeneration and partially prevents the decrease in glutamate receptor numbers caused by quinolinic acid. Thus, melatonin has the potential to reduce hippocampal neuronal damage induced by neurotoxins such as quinolinic acid.

Cerclage wiring in the management of comminuted fractures of the femoral shaft.

A retrospective series of 20 patients is presented, comprising 21 fractures of the femoral shaft treated by open reduction and internal fixation (usually by medullary nailing) combined with cerclage wiring. Most of the patients were young with comminuted fractures of the femoral shaft, many with multiple injuries. The aims of stable reduction and early sound union of the fracture in anatomical position were achieved in all cases and that of early mobilization of the knee to a good ultimate range of flexion in almost all cases.

An unusual case of torticollis.

A case is presented of a 9-year-old boy who developed torticollis caused by fibrosis at the site of a former ventriculoperitoneal shunt.

Delayed tarsometatarsal joint dislocation following forefoot injury.

Presented is a case of a delayed dislocation of the tarsometatarsal joints following an apparent simple strain with no displacement. Open reduction was successfully performed five weeks following the injury. The difficulties assessing these potentially unstable injuries are discussed.

Metacarpal lengthening.

Reduction deficits of metacarpals requiring treatment are an uncommon problem. A patient with bilateral short ring fingers is reported and a technique of Z lengthening is described.