Is routine splintage following primary total knee replacement necessary? A prospective randomised trial.

It was hypothesised that routine splintage following primary total knee replacement has no affect on flexion deformity and offers no benefit over simple wool and crepe. Fifty-five patients undergoing primary total knee replacement were entered into a prospective study. The patients were randomly assigned to two groups: The first group was rehabilitated without a splint and the second received an adjustable semi-rigid extension splint (Richards splint) for the first 48 h after surgery. Range of motion measurements were recorded pre-operatively and at 2 days, 1 week and 3 months post-operation by a research nurse blinded to the allocation. No statistically significant difference in flexion deformity was found at any stage (P>0.5). No difference was found in general or wound complications, or requirement for blood transfusion, and the post-operative stay was equal in the two groups. We conclude that routine use of a semi-rigid splint following primary total knee replacement has no advantage over simple wound dressings.

Acute fractures of the scaphoid. Treatment by cast immobilisation with the wrist in flexion or extension?

Acute fractures of the scaphoid were randomly allocated for conservative treatment in a Colles'-type plaster cast with the wrist immobilised in either 20 degrees flexion or 20 degrees extension. The position of the wrist did not influence the rate of union of the fracture (89%) but when reviewed after six months the wrists which had been immobilised in flexion had a greater restriction of extension. We recommend that acute fractures of the scaphoid should be treated in a Colles'-type cast with the wrist in slight extension.

Analgesic effects of intraarticular bupivacaine after day-case arthroscopy.

A blind, prospective, randomized, controlled trial was conducted to assess the analgesic properties of intraarticular bupivacaine after day-case arthroscopy. Forty-eight patients undergoing routine arthroscopy were randomly allocated to receive 10 ml of 0.5% bupivacaine or 0.9% saline into the joint at the end of the procedure. The analgesic effects were assessed by visual analogue scales at discharge, on going to bed, and the following morning. Significant reduction in reported pain was found in the treatment groups on leaving the hospital and later the same evening, although no benefit was found the following day.

Arthroscopy in the elderly.

Arthroscopy of the knee is an accepted and widely practised diagnostic and therapeutic procedure. The role of arthroscopy in the elderly is examined in this study. The benefit of debridement in the control of symptoms in the degenerative knee even in this elderly population is demonstrated. Arthroscopy produced an improvement in 62.3% of patients and in those whose knees were being assessed for osteotomy or arthroplasty 55% have avoided further surgery.

A case of military Munchausen's syndrome.

Since its initial description in 1951 many variants of Munchausen's Syndrome have been described. This present case report is of a patient who adopts military rank in order to gain admission to a service hospital: a case of Military Munchausen's Syndrome.