Evaluation of hemostatic changes using n thromboelastography after crystalloid or colloid fluid administration during major orthopedic surgery

The effects of Ringer lactate, 6% hydroxyethyl starch (HES) (130/0.4) or 4% succinylated gelatin solutions on perioperative coagulability were measured by thromboelastography (TEG). Seventy-five patients (ASA I-III) who were to undergo major orthopedic procedures performed under epidural anesthesia were included in the study. Patients were randomly divided into three groups of 25 each for the administration of maintenance fluids: group RL (Ringer lactate), group HES (6% HES 130/0.4), and group JEL (4% gelofusine solution). Blood samples were obtained during the perioperative period before epidural anesthesia (t1, baseline), at the end of the surgery (t2), and 24 h after the operation (t3). TEG data, reaction time (R), coagulation time (K), angle value (α), and maximum amplitude (MA) were recorded. TEG parameters changed from normal values in all patients. In group RL, R and K times decreased compared to perioperative values while the α angle and MA increased (P < 0.05). In group HES, R and K times increased, however, the α angle and MA decreased (P < 0.05). In group JEL, R time increased (P < 0.05), but K time, α angle and MA did not change significantly. In the present study, RL, 6% HES (130/0.4) and 4% JEL solutions caused changes in the coagulation system of all patients as measured by TEG, but these changes remained within normal limits.

Evaluation of hemostatic changes using n thromboelastography after crystalloid or colloid fluid administration during major orthopedic surgery.

The effects of Ringer lactate, 6% hydroxyethyl starch (HES) (130/0.4) or 4% succinylated gelatin solutions on perioperative coagulability were measured by thromboelastography (TEG). Seventy-five patients (ASA I-III) who were to undergo major orthopedic procedures performed under epidural anesthesia were included in the study. Patients were randomly divided into three groups of 25 each for the administration of maintenance fluids: group RL (Ringer lactate), group HES (6% HES 130/0.4), and group JEL (4% gelofusine solution). Blood samples were obtained during the perioperative period before epidural anesthesia (t1, baseline), at the end of the surgery (t2), and 24 h after the operation (t3). TEG data, reaction time (R), coagulation time (K), angle value (α), and maximum amplitude (MA) were recorded. TEG parameters changed from normal values in all patients. In group RL, R and K times decreased compared to perioperative values while the α angle and MA increased (P < 0.05). In group HES, R and K times increased, however, the α angle and MA decreased (P < 0.05). In group JEL, R time increased (P < 0.05), but K time, α angle and MA did not change significantly. In the present study, RL, 6% HES (130/0.4) and 4% JEL solutions caused changes in the coagulation system of all patients as measured by TEG, but these changes remained within normal limits.

[Giant-cell tumor of the hand: midterm results in five patients]. / Tumeur à cellules géantes de la main: résultats du traitement: 5 cas au recul moyen de 7, 8 ans.

PURPOSE OF THE STUDY: Giant-cell bone tumors are benign but have great potential for recurrence. Frequently observed in epiphyseal areas of tubular bones, these tumors are rarely found in hand localizations. We examined the characteristic features of giant-cell tumors of the hand and analyzed the pertinence of surgical treatment. We noted complications, consequences of recurrence and later operations on the same tumor site in five cases. CASE REPORTS: Five patients treated between 1973 and 2000 for giant-cell tumors involving the hand bones were reviewed retrospectively. Mean age was 41.6 years and mean follow-up was 7.8 years. The surgical procedure was curettage for two, curettage with bone graft for two and amputation for one. The Enneking score was noted. RESULTS: Pain was the main symptom, with local swelling in several cases. At 7.8 years follow-up recurrence was noted for four of the five tumors. Two patients were treated for a second recurrence. Amputation of the forearm was required for one recurrence affecting soft tissue. Mean time between two consecutive recurrences was three months. In all six episodes of recurrent tumor were treated. These five patients had a total of ten operations. There were no cases of metastasis nor multicentric foci. DISCUSSION: Treatment of giant-cell tumors involving the hand bones is designed to eradicate the tumor and also protect hand function while keeping in mind the aggressive nature of these benign tumors. Surgical alternatives for radical treatment can include wide resection, resection of the ray and amputation.

Ganglion cysts of the proximal tibiofibular joint review of literature with three case reports.

Proximal tibiofibular ganglion is a rare disorder. It may settle down in the subcutaneous tissue or may develop along the peroneal muscles and nerve. Common clinical findings are various sizes of mass, pain and hypoesthesis due to compression neuropathy. We report three cases of proximal tibiofibular ganglion and review the literature about the diagnostic tools, recurrence rates and treatment modalities.

Intra-articular fractures of the tibial plafond. A comparison of the results using articulated and ring external fixators.

We retrospectively reviewed 60 fractures of the tibial plafond treated by either an ankle-sparing diaphyseal-epiphyseal technique using the Ilizarov ring fixator or by an ankle-spanning technique using a monolateral articulated external fixator. The Ilizarov ring fixator was applied in 24 fractures and the monolateral articulated transarticular external fixator in 20. Both techniques were combined with limited open reduction and internal fixation of the articular surface if necessary. Between three and nine years after the injury, all patients returned for clinical and radiological assessment and evaluation of ankle function using the modified Mazur score. There were no significant differences between the two groups in terms of age, gender, mechanism of injury, type of fracture or length of follow-up. The mean functional ankle score was 86 points for the Ilizarov group and 82 points for the articulated fixator group. The difference was not significant (p = 0.07). There were no significant differences between the groups with regard to the radiographic score and late complications. Patients treated with the Ilizarov ring fixator had significantly better ankle and subtalar movement. We conclude that both techniques of external fixation are satisfactory methods of treatment for fractures of the tibial plafond, but that the total arc of movement of the joint is preserved better without bridging the ankle.