Continuous femoral blocks improve recovery and outcome of patients undergoing total knee arthroplasty.

This study was designed to determine the effects of continuous femoral infusion (CFI) on total knee arthroplasty recovery. A total of 92 patients were distributed in 3 groups: Patients in group 1 received general anesthesia followed by patient-controlled analgesia (PCA) with morphine (n = 33), patients in group 2 received 3-in-1 and sciatic blocks followed by CFI (n = 29), and patients in group 3 received epidural analgesia (n = 30). Blocks reduced postoperative morphine requirement by 74% (vs group 1; P<.05) and 35% (vs group 3; P<.05). Blocks provided better recovery than PCA with morphine or an epidural. The use of CFI was associated with a reduction of postoperative bleeding by 72% (vs group 1; P<.05) and allowed better performance on continuous passive motion. CFI was associated with a 90% decrease in serious complications and a 20% decrease in the length of hospitalization. CFI represents a better alternative than PCA or epidural analgesia for postoperative pain management and immediate rehabilitation after total knee arthroplasty.

Dynamic external fixation for comminuted intra-articular fractures of the distal end of the radius.

An external fixation device that allows motion of the wrist was developed for the treatment of severely comminuted intra-articular fractures of the distal end of the radius, and in specimens from cadavera that motion was demonstrated with the device in place. Thirty patients who had thirty-two comminuted intra-articular radial fractures were then treated with fixation using this device during a six-month interval. Thirty-one of the wrists were examined at follow-up one and two years later. The first fifteen wrists that were allowed full flexion and extension immediately postoperatively had lost some volar tilt postoperatively. The other patients, for whom only flexion was allowed immediately postoperatively, while extension was allowed four weeks later, did not lose volar tilt. The device maintained the reduction of the fracture fragments and allowed the early return of a functional range of motion of the wrist.