Postoperative pain management with transdermal fentanyl after forefoot surgery: a randomized, placebo-controlled study.

BACKGROUND: Quality of life is decreased in patients with hallux valgus deformity, mainly because of pain. Significant improvement is usually achieved by surgery. However, postoperative pain can be moderate to severe for 2-3 days. The aim of the present study was to evaluate the use of transdermal fentanyl for postoperative pain management after forefoot surgery. METHODS: Sixty patients undergoing hallux valgus or hallux rigidus surgery were allocated to receive a patch delivering either fentanyl 12 µg/hour or placebo for postoperative pain. The consumption of rescue opioid oxycodone, the primary outcome measure, was evaluated daily until the fourth postoperative day. Total consumption of oxycodone during the study period was also assessed. Pain scores and possible adverse effects were evaluated every 6 hours during the first 24 hours and on the fourth postoperative day. RESULTS: The use of rescue opioid was low in both groups, the median (range) consumption of oxycodone being 10 (0-50) mg on the day of surgery (no difference between the groups, P=0.31) and 0 (0-35) mg thereafter. The total combined consumption was 10 (0-105) mg in the fentanyl group and 20 (0-70) mg in the placebo group (P=0.23). There were no statistically significant differences in pain scores or adverse effects between the groups. CONCLUSION: As a part of multimodal analgesia with ibuprofen and acetaminophen, a patch delivering fentanyl 12 µg/hour did not significantly decrease the consumption of rescue opioid or pain scores after forefoot surgery.

Tension-band wiring for fractures of the fifth metatarsal located in the junction of the proximal metaphysis and diaphysis.

BACKGROUND: Fractures of the proximal fifth metatarsal, other than those involving the tuberosity, have a tendency to delayed union or even nonunion. HYPOTHESIS: Tension-band wire technique is a good alternative in treating fractures of the fifth metatarsal located in the proximal junction of the metaphysis and the diaphysis. STUDY DESIGN: Case series; level of evidence, 4. METHODS: Between 1996 and 2001, a total of 27 cases of proximal metaphysial/diaphysial fractures of the fifth metatarsal were treated with tension-band wiring. All of the patients had undergone prior unsuccessful nonoperative or operative treatment. The mean delay from the diagnosis of the fracture to the final operative procedure was 19.5 weeks (range, 6-48 weeks). RESULTS: The mean length of follow-up was 35 months (range, 12-70 months). All patients were able to return to their prior levels of activity. The mean time for union as shown on radiographs was 12.8 weeks, and the return to full activity took 8 to 20 weeks (mean, 14.7 weeks). There were no delayed unions, nonunions, or refractures during the follow-up. CONCLUSION: The tension-band wire technique seems to give good results in the treatment of proximal metaphysial/diaphysial fractures of the fifth metatarsal in cases of primary unsuccessful nonoperative treatment or primary unsuccessful intramedullary screw fixation.

Observation of anomalous insertion of the medial meniscus on the anterior cruciate ligament.

We wanted to determine the frequency of occurrence and types of anomalous insertions of the medial meniscus to the anterior cruciate ligament (ACL) in Finnish patients. In 987 consecutive arthroscopies from January 1996 to August 1998, the meniscal pathology was mapped using videoprints and drawings. We found 11 anomalous medial meniscus insertions to the ACL. There were 4 female and 6 male patients in the series. In 1 woman, the anomaly was bilateral. The mean age of the patients was 30.6 years (range 14 to 63 years). The anomalous band was excised in all patients. The anomaly usually was not the finding that caused the need for arthroscopy. In 3 knees, the anomaly was the only pathologic finding. The frequency of this anomaly occurring was approximately 1.2%. The anomalous medial meniscus insertion to the ACL is a very rare clinical finding. Arthroscopic surgeons should be aware of its existence as well as of other anterior horn insertion variations of the medial meniscus.