The radiographic quality of conservatively managed distal radius fractures in adults using haematoma block versus intravenous sedation.

OBJECTIVE: We compared the radiographic quality of initial reduction of distal radius fractures reduced using haematoma block to those reduced with intravenous sedation. The overall rate of re-manipulation and complications were noted. METHODS: A prospective study carried out at the emergency unit of our hospital between 1st September, 2017 and 31st December, 2018. Patients were consecutively recruited into Haematoma Block (HB) and Sedation(S) groups using the simple balloting method. After 5-10 min of administering anaesthesia, the fracture was reduced and immobilized in a below-to-elbow Plaster of Paris (P.O.P) cast for 6 weeks. The pre- and post-reduction radiographs were reviewed for volar tilt, radial angulation, radial deviation and radial shortening. RESULTS: Sixty-seven patients completed the study with 33 patients in HB group and 34 patients in S group. There was no significant difference in the radiographic quality of initial reduction between the two groups using the Sarmiento's modification of Lindström criteria (p = 0.49). Five out of 34 patients among the sedated group had gastrointestinal symptoms. The overall rate of re-manipulation was low and the complications recorded were wrist stiffness and residual wrist deformity. CONCLUSION: Our study revealed that there was no significant difference in the radiographic quality of initial reduction between the groups. Excellent to good reduction was achieved with both anaesthetic options. The choice of anaesthesia should be individualized and based on surgeons' preference.

Comparison of postoperative alignment using fixed angle versus variable angle distal femoral resection in uncomplicated total knee replacement.

PURPOSE: This study aimed to compare the postoperative alignment of the lower limbs using fixed angle versus variable valgus angle distal femur resection in uncomplicated total knee replacement (TKR) and to determine the mean valgus correction angle (VCA) in the study population. METHODS: This was a prospective comparative study conducted between July 2018 and December 2019 in patients with osteoarthritic knees who underwent primary TKR. Forty-nine patients with 54 knees completed the study. They were randomized into fixed valgus angle (group A) and variable valgus angle (group B) groups. Twenty-four patients with 26 knees were in group A who had distal femur resection with 5-degree valgus correction, while 25 patients with 28 knees were in group B who had distal femur resection with individualized valgus correction angle calculated from hip-knee-ankle scanogram. RESULTS: The demographic data were comparable in the two groups. There was no statistically significant difference between the groups in the mean preoperative mechanical femorotibial angle (MFTA). The fixed angle group had a mean postoperative MFTA of 2.0 ± 2.8°, while variable angle group had a mean of 1.6 ± 2.4°. However, the difference between the groups did not reach statistical significance (p = 0.60). The mean VCA in the study population was 5.8 ± 1.2° (Range 4-9°). CONCLUSION: Our study has shown that the use of variable valgus angle for distal femur resection in uncomplicated TKR did not significantly improve the accuracy of restoring the postoperative coronal alignment within 0 ± 3°.

An Evaluation of Intra- and Post-operative Blood Loss in Total Hip Arthroplasty at the National Orthopaedic Hospital, Lagos.

BACKGROUND: Severe hip pain with associated significant functional limitation is the major indication for total hip replacement, a rewarding and gratifying procedure. However, significant blood loss can occur in the intra- and post-operative periods, posing a major challenge and necessitating prompt restoration of circulating blood volume to minimize morbidity and mortality. The aim of this study was to evaluate blood loss after primary total hip replacement, and to determine the effect of surgical time on blood loss. PATIENTS AND METHODS: A prospective study of blood loss after total hip arthroplasty in 41 patients. All cases were primary total hip arthroplasty done by one surgeon. Intra- and post-operative blood losses were recorded in two groups of patients (surgical time <2 h and surgical time >2 h), and the effect of these on blood loss was evaluated. RESULTS: The mean intra- and post-operative blood losses were 1222.7 ml and 574.3 ml, respectively. These showed a strong positive correlation with total blood loss (r = 0.790, P < 0.001 and r = 0.517, P < 0.001). Higher intra- and post-operative blood losses were recorded in patients with surgical time >2 h, with a significant difference on postoperative days 2 and 3 (P = 0.003 and P = 0.014, respectively). CONCLUSION: Blood loss in total hip replacement is an important factor and may be influenced by a shorter surgical time.

An evaluation of intra- and post-operative blood loss in total hip arthroplasty at the national orthopaedic hospital, Lagos

Background: Severe hip pain with associated significant functional limitation is the major indication for total hip replacement, a rewarding and gratifying procedure. However, significant blood loss can occur in the intra- and post-operative periods, posing a major challenge and necessitating prompt restoration of circulating blood volume to minimize morbidity and mortality. The aim of this study was to evaluate blood loss after primary total hip replacement, and to determine the effect of surgical time on blood loss. Patients and Methods: A prospective study of blood loss after total hip arthroplasty in 41 patients. All cases were primary total hip arthroplasty done by one surgeon. Intra- and post-operative blood losses were recorded in two groups of patients (surgical time <2 h and surgical time >2 h), and the effect of these on blood loss was evaluated. Results: The mean intra- and post-operative blood losses were 1222.7 ml and 574.3 ml, respectively. These showed a strong positive correlation with total blood loss (r = 0.790, P< 0.001 and r = 0.517, P< 0.001). Higher intra- and post-operative blood losses were recorded in patients with surgical time >2 h, with a significant difference on postoperative days 2 and 3 (P = 0.003 and P = 0.014, respectively). Conclusion: Blood loss in total hip replacement is an important factor and may be influenced by a shorter surgical time