Optimizing Tourniquet Pressure in Primary Total Knee Arthroplasty: Limb Occlusion Pressure vs Systolic Blood Pressure Method: A Randomised Controlled Study.

Background: This study aims to systematically compare the efficacy of two distinct approaches that is limb occlusion pressure (LOP) and systolic blood pressure (SBP) in determining the optimal tourniquet pressure for primary total knee arthroplasty. The overarching goal is to identify the method that yields superior outcomes in minimizing post-operative thigh pain while simultaneously reducing complications in our patient population. Methods: 311 patients scheduled for primary total knee replacement (TKR) were randomized in two groups. Group A (LOP) had 154 patients and group B had 157 patients. In group A, LOP was determined for all patients. After adding the safety margin, the tourniquet pressure was determined which was kept during the procedure. By adding 150 mm Hg to SBP in group B, the tourniquet inflation pressure was ascertained. Postoperatively, thigh pain was evaluated from day 1 to day 3 and at 6 weeks. Results: The average tourniquet pressure in group A patients having thigh circumference between 40 and 50 cm was 223.8 mm + - 19.8 mm Hg and in group B it was 262.1 + - 15.9 mm Hg (P < .01). Patients having thigh circumference between 51 and 60 cm had average tourniquet pressure of 240.07 + - 20.1 mm Hg in group A and 264.5 + - 17.4 mm Hg in group B (P < .01). The average tourniquet pressure for patients with thigh circumference more than 60 cm was 296 + /15.3 mm Hg in group A and 267.3 + /19.2 mm Hg in group B (P < 0.01). Conclusion: Tourniquet pressure determination based on the limb occlusion pressure (LOP) method provide less postoperative thigh pain and better range of motion. Graphical Abstract: Optimizing Tourniquet Pressure in Primary Total Knee Replacement: Limb Occlusion Pressure vs Systolic blood pressure method to minimize thigh pain.

Medial pivot dislocation of talonavicular joint- A rare injury with literature review.

Medial pivot dislocations are dislocation of talonavicular joint (TNJ) medially with calcaneum subluxate beneath the talus with intact calcaneocuboid joint and interosseous ligament. These dislocations have subtle incidence and are mostly related to high energy injuries. These dislocations are easy to reduce having good functional outcome if diagnosed early. We presented two cases of young active patients who sustained injury to their foot after fall from height and road traffic accident. There were diffuse swelling and tenderness over the foot. X-ray showed medial dislocation of TNJ. Closed reduction was done in both patients. One patient needs percutaneous K-wire fixation. At one year follow-up, foot was painless, stable with normal ankle and subtalar motion.

Augmentation of elastic stable intramedullary nail with external fixator in the management of comminuted shaft femur fracture in adolescents.

BACKGROUND: The management of adolescent femur fractures continues to evolve and remains controversial. Currently, operative fixation methods are favoured, offering options such as external fixator, flexible and locked intramedullary nailing, compression and locked plating. Our study aims to introduce a novel approach for treating adolescent femoral shaft fractures by combining an external fixator with an elastic stable intramedullary nail. MATERIAL AND METHODS: We included 32 patients aged 11-16 years with femoral shaft fractures treated using an external fixator augmented elastic intramedullary nail at our institution from August 2015 to January 2019. RESULTS: All patients achieved bony union. We analysed patient's results both clinically and radiologically. On average, the surgery took 77.34 minutes to complete with an average time to union of 13.9 weeks. External fixator and elastic nail removal took an average of 3.59 months and 26.5 months, respectively. At the final follow-up, knee range of motion averaged 131.88 degrees. According to the Flynn criteria, functional outcomes were excellent in 18 patients, satisfactory in 11 patients and poor in 3 patients. Pin site infection occurred in 3 patients, malunion in 4 patients, limb length shortening < 1 cm in 3 patients, distal nail tip prominence and knee stiffness in 3 patients. CONCLUSION: The management of femur fractures in adolescents using an elastic nail augmented with an external fixator is a minimally invasive procedure that provide secure fracture stabilization and predictable outcomes.