RESUMO
BACKGROUND: Knee pain is a common problem in the general population. In order to determine the extent of the injury and the appropriate treatment, MRI provides the most accurate imaging method. This may be done through conventional MRI techniques or by injecting a contrast material (MR arthrography). OBJECTIVES: The purpose of this study was to compare the diagnostic value of these two methods. PATIENTS AND METHODS: The study involved the diagnostic evaluation on 60 patients with knee pain who received treatment over the course of a one-year period. Referred patients were randomly divided into two groups: indirect MR arthrography was performed on one group, and conventional MRI was performed on the other group. Both groups then underwent arthroscopy. The results from both groups were compared with the arthroscopic findings. RESULTS: In all of the pathologies studied, the sensitivity, specificity, and the positive and negative predictive values were evaluated. A high rate of accuracy was found between MR arthrography and arthroscopy (P < 0.05) for all knee injuries, however a similar rate of accuracy between conventional MRI and arthroscopy was only seen in patients with damage to the posterior cruciate ligament (PCL), the tibio-femoral articular cartilage, and patella chondromalacia (P < 0.05). The highest rate of accuracy was seen in cases where indirect MR arthrography was used for the diagnosis of anterior cruciate ligament (ACL) damage (K = 1). CONCLUSIONS: Our results have shown that indirect MR arthrography had greater diagnostic accuracy in regards to the sensitivity, specificity, and positive and negative predictive values than conventional MRI in knee pathologies.
RESUMO
BACKGROUND: Lack of proper control of acute postoperative pain often leads to lingering or chronic pain. Several studies have emphasized the role of beta-blockers in reducing postoperative pain. Esmolol is a selective short-acting beta-blocker that produces few side effects. The purpose of this study was to examine the effect of intravenous intraoperative esmolol on postoperative pain reduction following orthopedic leg fracture surgery. METHODS: In a clinical trial, 82 patients between 20-65 years of age with tibia fractures and American Society of Anesthesiologists (ASA) physical status I & II who underwent surgery were divided into two groups. Group A received esmolol and group B received normal saline. Postoperative pain was measured at three time points: entering the recovery unit, and at 3 h and 6 h following surgery, using the Visual Analogue Scale (VAS). A P value of < 0.05 was considered significant. RESULTS: Mean VAS scores at all three time points were significantly different between the two test groups (P = 0.02, P = 0.0001, and P = 0.0001, respectively). The consumption of pethidine was lower in group A than in group B (P = 0.004) and the duration of its effect was significantly longer in time (P = 0.026). CONCLUSIONS: Intravenous intraoperative esmolol is effective in the reduction of postoperative pain following leg fracture surgery. It reduced opioid consumption following surgery and delayed patient requests for analgesics.
RESUMO
Fixation of subtrochanteric fracture, even for experienced surgeons, is a challenge. This fracture is most difficult to treat, and the incidence of complications in this type of fracture is higher. This study compared surgical results of two methods, proximal femur locking compression plate and intramedullary locking nail. This is an analytic study, performed on all patients with subtrochanteric fracture who were referred to the hospital during 3 years. They were treated with proximal femur locking plate or intramedullary locking nail. The postoperative complications were evaluated and recorded. Finally, the data were analyzed by SPSS software. Complications were studied in both groups. Neither treatment has statistically significant difference in complications, onset of complications incidence, and time of full-weight bearing. Although the Harris Hip Score among patients improved in both methods of treatment, there is no significant difference between the two groups. The results of subtrochanteric fracture fixation by intramedullary or locking plate were similar and had the same outcome.
