Closed vs open nailing for displaced middle third fracture of clavicle. Does it matter?

BACKGROUND: Intramedullary nailing for fractures of middle third clavicle has become increasingly popular. Though open nailing has been widely described, closed nailing finds less mention. OBJECTIVES: In this study we compared closed nailing with open nailing in fractures of middle third of clavicle to assess if the former holds any advantage. MATERIAL AND METHODS: 34 patients with closed nailing were compared to 31 patients with open nailing in terms of operative time, length of incision, pain, time to union and functional outcome. RESULTS: Only operative time and length of incision were significantly more in open group than in closed group. DISCUSSION: We believe that closed reduction can be attempted in all patients undergoing nailing for middle third clavicle fracture but surgeon should have a low threshold to open the fracture if closed reduction fails as functional outcome and time to union remains unaffected.

Epidural versus intra-articular infusion analgesia following total knee replacement.

PURPOSE: To compare the efficacy of epidural versus intra-articular infusion analgesia following total knee replacement (TKR). METHODS: 25 men and 50 women aged 55 to 75 (mean, 67) years who underwent primary TKR by a single surgeon were randomised and consented to receive either epidural (n=35) or intra-articular (n=40) infusion analgesia for 48 hours at 5 ml/ hr. All patients also received intravenous aqueous diclofenac 50 mg twice a day. Patients were assessed 6 hourly for visual analogue score (VAS) for pain to determine the analgesic effect. Complications such as paraesthesia in the lower limbs, hypotension, urinary retention, and abdominal distension were recorded, as was the rehabilitation progress with respect to the time to stand, climb stairs, use of commode chair, and discharge. RESULTS: The epidural and intra-articular infusion groups were comparable with respect to age, sex, weight, and operating time, as was the analgesic efficacy within 48 hours of TKR. Patients with epidural infusion analgesia had a higher complication rate in terms of hypotension (51.4% vs. 22.5%, p=0.015) and troublesome paraesthesia in the lower limbs (45.7% vs. 12.5%, p=0.028), and a trend of higher abdominal distension rate (20% vs. 5%, p=0.073). Patients with intra-articular infusion analgesia were able to stand/ walk earlier (2.08 vs. 2.54 days, p<0.001). The 2 groups did not differ significantly in the time needed to climb stairs, use of commode chair, and discharge. CONCLUSION: The efficacy of epidural and intraarticular infusion analgesia was comparable. Intra-articular infusion was associated with fewer complications and earlier rehabilitation.

Accidental ingestion of endodontic file: a case report.

Ingestion of the endodontic instrument during root canal treatment is rare but can result in serious complications. The present paper reports a case in which endodontic file was accidentally swallowed by the patient undergoing root canal therapy, which entered digestive tract and passed uneventfully.