Comparison of the Effect of Continuous Femoral Nerve Block and Adductor Canal Block after Primary Total Knee Arthroplasty

BACKGROUND: This study aimed to compare the effects of femoral nerve block and adductor canal block on postoperative pain, quadriceps strength, and walking ability after primary total knee arthroplasty. METHODS: Between November 2014 and February 2015, 60 patients underwent primary total knee arthroplasty. Thirty patients received femoral nerve block and the other 30 received adductor canal block for postoperative pain control. Before spinal anesthesia, the patients received nerve block via a catheter (20 mL 0.75% ropivacaine was administered initially, followed by intermittent bolus injection of 10 mL 0.2% ropivacaine every 6 hours for 3 days). The catheters were maintained in the exact location of nerve block in 24 patients in the femoral nerve block group and in 19 patients in the adductor canal block group. Data collection was carried out from these 43 patients. To evaluate postoperative pain control, the numerical rating scale scores at rest and 45° flexion of the knee were recorded. To evaluate quadriceps strength, manual muscle testing was performed. Walking ability was assessed using the Timed Up and Go test. We also evaluated analgesic consumption and complications of peripheral nerve block. RESULTS: No significant intergroup difference was observed in the numerical rating scale scores at rest and 45° flexion of the knee on postoperative days 1, 2, 3, and 7. The adductor canal block group had significantly greater quadriceps strength than did the femoral nerve block group, as assessed by manual muscle testing on postoperative days 1, 2, and 3. The 2 groups showed no difference in walking ability on postoperative day 1, but on postoperative days 2, 3, walking ability was significantly better in the adductor canal block group than in the femoral nerve block group. No significant intergroup difference was observed in analgesic consumption. CONCLUSIONS: The groups showed no difference in postoperative pain control. Adductor canal block was superior to femoral nerve block in preserving quadriceps strength and walking ability. However, adductor canal block was inferior to femoral nerve block in maintaining the exact location of the catheter.

Complications and Short-Term Outcomes of Medial Opening Wedge High Tibial Osteotomy Using a Locking Plate for Medial Osteoarthritis of the Knee

PURPOSE: The purpose of this study was to investigate complications and radiologic and clinical outcomes of medial opening wedge high tibial osteotomy (MOWHTO) using a locking plate. MATERIALS AND METHODS: This study reviewed 167 patients who were treated with MOWHTO using a locking plate from May 2012 to June 2014. Patients without complications were classified into group 1 and those with complications into group 2. Medical records, operative notes, and radiographs were retrospectively reviewed to identify complications. Clinically, Oxford Knee score and Knee Injury and Osteoarthritis Outcome score (KOOS) were evaluated. RESULTS: Overall, complications were observed in 49 patients (29.3%). Minor complications included lateral cortex fracture (15.6%), neuropathy (3.6%), correction loss (2.4%), hematoma (2.4%), delayed union (2.4%), delayed wound healing (2.4%), postoperative stiffness (1.2%), hardware irritation (1.2%), tendinitis (1.2%), and hardware failure without associated symptoms (0.6%). Major complications included hardware failure with associated symptoms (0.6%), deep infection (0.6%), and nonunion (0.6%). At the first-year follow-up, there were no significant differences in radiologic measurements between groups 1 and 2. There were no significant differences in knee scores except for the KOOS pain score. CONCLUSIONS: Our data showed that almost all complications of the treatment were minor and the patients recovered without any problems. Most complications did not have a significant impact on radiologic and clinical outcomes.

Little Leaguer Shoulder with Contralateral Thrower's Fracture of the Humerus in Adolescent Baseball Pitchers / 대한정형외과학회잡지

Baseball-related injuries are on the rise due to its increasing popurity as an international sports. Among them, Little League Shoulder is characterized by pain when pitching and is associated with specific roentgenographic changes in adolescent baseball pitchers. Ball thrower's fracture is defined as a fracture of the humeral diaphysis resulting from overhead throwing without any external contact but it is rare in adolescents. We report a case of Little League Shoulder with a contralateral thrower's fracture of the humeral shaft related to baseball pitching in an ambidextrous adolescent baseball pitcher with a review of the relevant literature.

Lifestyle Recommendations for Dementia Prevention: PASCAL

The increasing number of persons with dementia poses a serious threat to public health in an aging society. Efforts to curb the rising prevalence of dementia have directed attention to health promotion as a viable strategy for delaying dementia onset and maintaining cognitive function in later life. For the latter purpose, public recommendations were developed based on a systematic review of the literature. Significant lifestyle variables found to predict cognitive function and dementia in later life were physical activity, non-smoking, social activity, cognitive activity, moderate alcohol consumption, normal body weight (BMI), and healthy nutrition and diet (fish, vegetables, fruits, vitamin C and E, etc.). Cognitive health recommendations were developed and named PASCAL, an acronym for (1) Physical activity, (2) Anti-smoking, (3) Social activity, (4) Cognitive activity, (5) Alcohol drinking in moderation, and (6) Lean body mass and healthy diet. These recommendations can be used to educate the public and raise awareness in health professionals to the important role a healthy lifestyle plays in maintaining cognitive health in later life.