Proximal Hamstring Repair - Surgical Pearls for the Novice.

Introduction: Proximal hamstring injuries are rarely encountered sport injuries which cause great functional impairment in the activities of performance. Since these injuries are rarely encountered in orthopedic training, many young surgeons find it challenging to explore and successfully perform the required repairs. The technical demands of tendon retraction, scar tissue formation along with a great possibility of nerve injury during surgical dissection make these procedures a nightmare for young surgeons. Results: Between January 2020 and December 2021, 11 patients underwent a proximal hamstring repair at our practice. All cases were of acute hamstring tears and diagnosed on magnetic resonance imaging (MRI) evaluation post-injury. No repeat MRI was performed but the patients outcomes were judged based on clinical outcomes such as return to sport or the presence of residual pain. All patients reached their pre-injury level of activity within 6 months of surgical repair. Conclusion: This technical note describes pearls of surgical repair of these injuries that help in better execution of such injuries with minimal soft tissue damage and complications.

One single large intramuscular dose of naloxone is effective and safe in suspected heroin poisoning.

OBJECTIVE: Naloxone is an established antidote for the treatment of heroin poisoning; however, dosing regimens vary widely, with a current trend towards small titrated intravenous dosing. This study aims to characterise naloxone use in the treatment of patients presenting with suspected heroin poisoning. METHODS: This was a retrospective review of poisoned patients presenting to a clinical toxicology unit in Brisbane from January 2015 to December 2017. Patient demographics, clinical effects, naloxone dosing, observation periods and complications were extracted from the patient's medical records. RESULTS: There were 117 presentations accounted for by 108 patients. Prehospital naloxone was provided to 57 (49%) patients, 46 of which received a standardised 1.6 mg i.m. dose. The remaining 60 (51%) patients received their first naloxone in hospital, with 58 (97%) receiving this by titrated i.v. doses. A subsequent naloxone infusion was required significantly more often in those treated with i.v. titrated naloxone compared to i.m. dose (27/69 [39%] vs 5/48 [10%], P = 0.0006). The need for parenteral sedation to manage acute behavioural disturbance following naloxone provision was rare (3/117 [3%]). CONCLUSIONS: In this retrospective observational study, a single large i.m. dose of naloxone reversed the toxicity of suspected heroin overdose in the majority of patients. In addition, patients were less likely to require repeated intermittent doses or naloxone infusion than those treated solely with i.v. naloxone. Further comparison in a prospective study is warranted to validate these observations in confirmed heroin overdose. Requirement for sedation secondary to acute behavioural disturbance was rare regardless of the route.