Sliding screw in the treatment of trochanteric and subtrochanteric fractures

From spring 1979 all patients with trochanteric and subtrochanteric fractures treated at Aarhus County Hospital have been operated on with the sliding nail, and the patients' progress has been followed for 1 year. In this article the results from the 92 first operations are compared with the results from a controlled trial comparing Ender's nailing and McLaughlin's nail-plate fixation. The latter series originated from the same department but from 1976 until 1978.It was found that the time of anaesthesia in the Ender, the McLaughlin and in the sliding-nail group was 125, 131 and 145 minutes respectively. There was no significant difference in the occurrence of post-operative complications between the 3 groups. In the Ender group 56 per cent of the patients had technical complications compared with 23 per cent in the McLaughlin group. In the Ender group 14 per cent had second operations compared with only 3 per cent in the two other groups. The results at the 1-year follow-up examination were the best in the sliding-nail group. It was concluded that the use of the sliding nail carried great advantages compared with Ender nailing and McLaughlin nail plating.     

A comparative study of skin blood flow in musculocutaneous and random pattern flaps

The present study in dogs was performed to evaluate the development of blood flow in cranial-based, rectus abdominis musculocutaneous (MCF) and random pattern (RPF) flaps and in adjacent intact skin before and after operation. Prior to raising of the flaps the intact skin area had the same blood flow in all the test injections. Following flap elevation blood flow in the MCF increased and on the second postoperative day (POD) it was 2.6 times the preoperative value. From POD 2 through POD 15 only minor changes were found for blood flow in MCF. Blood flow in the RPF immediately after surgery was only 31% of the preoperative value and 24% of the MCF value. After POD 2-3 blood flow in RPF, however, increased and reached the preoperative level and continued to increase through POD 15. Intact adjacent skin showed changes similar to those of MCF through POD 6, however, by POD 15 blood flow had decreased and was lower than that in MCF and RPF. Blood flow rates at remote sites in the groin and shoulder were identical and showed only a slight increase during the first two postoperative days. It is concluded that MCF have an early and continuous increase in blood flow after raising, while RPF have an early decrease. RPF, however, develop a subsequent increase in flow lasting through POD 15. Intact adjacent skin also showed increased blood flow which could not be attributed to a generalized increase in skin blood flow.     

Preoperative Systemic Bone Quality Does Not Affect Tibial Component Migration in Knee Arthroplasty: A 2-Year Radiostereometric Analysis of a Hundred Consecutive Patients

BackgroundBone quality and other preoperative predictive factors may affect implant migration and the survival of knee arthroplasty.MethodsIn a prospective cohort of 100 consecutive patients (65 women) at a mean age of 67.7 years (range 39-87 years), we investigated preoperative predictors of postoperative tibial component migration in cemented and cementless total knee arthroplasties or cemented unicompartmental knee arthroplasty. Predictors consisted of Knee Injury and Osteoarthritis Outcome Score (KOOS) and Oxford Knee Score, questionnaires, bone turnover markers of CTX and P1NP, systemic bone mineral density (BMD), and knee osteoarthritis (OA) grade. Tibial component migration was measured with radiostereometry postoperative, at 1 and 2 years of follow-up.ResultsBetween 1 and 2 years, 19 tibial components migrated continuously (maximum total point motion [MTPM] > 0.2 mm). In general, there was no difference in age, body mass index, BMD, KOOSs, or OA grade between patients with continuous tibial migration compared to patients without continuous migration (P > .11). However, cementless tibial components with continuous migration had a lower KOOS pain score (more pain), lower vitamin D, and a higher bone turnover (CTX) value than patients without continuous migration. There was no association between the BMD and MTPM at 1-year follow-up regardless of prothesis type (P > .17). Patients with osteoporosis and normal BMD had similar mean tibial component MTPM at 2 years (3 prostheses combined; P = .34).ConclusionMigration of tibial components inserted with or without bone cement was not affected by the preoperative bone quality in terms of systemic BMD, bone turnover markers, and OA grade in the knee.     

Healing of incisional wounds in stomach and duodenum: A biomechanical study

The healing pattern of incisional wounds in the rat stomach and duodenum was determined. A model allowing the biomechanical determinations of complete load-deformation curves is described. Wounds were made in the nonglandular (rumen) and glandular oxyntic (corpus) parts of the stomach and in duodenum. The wounds were tested 5 to 40 days after operation.Of the intact tissues the nonglandular part of the stomach was found to be more extensible and required more energy to be ruptured than the glandular part of the stomach and duodenum. The healing wounds in the glandular part of the stomach and duodenum showed the most rapid increase in mechanical strength, and after 40 days both required more energy to be ruptured than intact tissue. Wounds in the nonglandular part of the stomach reached only 75 percent of intact strength value after 40 days. The process of wound healing resulted in an increase in tissue stiffness.These findings indicate that wound healing in stomach and duodenum is more rapid than that in most other tissues and that the load-strain data give a detailed picture of the healing process. The energy required to rupture a wound represents the most informative assessment of wound healing.     

Healing of incisional wounds in stomach and duodenum: Functional interaction between normal and wounded tissue

The development of mechanical strength in healing wounds in rat stomach and duodenum was correlated with changes in the morphologic characteristics of the wounds and adjacent tissue. Wounds were made in the nonglandular (rumen) and the glandular oxyntic (corpus) parts of the stomach and in duodenum. The wounds were tested 5 to 40 days after operation. Biomechanical analysis showed that in intact tissues the nonglandular part of the stomach was more extensible and required more energy to rupture than the glandular part of the stomach and duodenum. The wounds tested together with adjacent tissue had less mechanical strength, but a pattern of strength development similar to that found in earlier studies where isolated wound tissue was investigated. Morphologic analysis showed that with healing time the point of maximal weakness moved laterally from the incision line, and that the rupture pattern was the same in all types of tissues postoperatively. These findings indicate that suture materials and technique are important throughout the early period of wound healing in stomach and duodenum, while the influence of sutures becomes negligible later on, when the weakest point of the healing wound is outside the tissue enclosed by the sutures.     

Continuous direct tissue oxygen tension measurement by a new method using an implantable silastic tonometer and oxygen polarography

A new method of tissue oxygen tension measurement that is suitable for human use has been described. An implanted Silastic tube tonometer is combined with polarographic oxygen electrodes. The techniques of preparation, insertion, and measurement have been described. The advantages and disadvantages of this method have been considered in relation to established methods of tissue oxygen tension measurement. The method is suitable for clinical use and can be used to aid clinical decision-making.     

Healing of incisional wounds in stomach and duodenum: Collagen distribution and relation to mechanical strength

The present study was performed to determine the changes in and distribution of collagen concentration around a healing incision in rat stomach and duodenum. These concentrations were related to the mechanical properties presented previously. Wounds were made in the nonglandular (rumen) and the glandular oxyntic parts (corpus) of the stomach and in duodenum. Specimens were cut parallel to the incision line and hydroxyproline contents and dry defatted weight were measured. Wounds were investigated 5 to 40 days after operation.Of the intact tissues the nonglandular part of the stomach had twice the collagen concentration of the glandular oxyntic part and duodenum, which did not differ from each other. The healing wounds in the glandular oxyntic part of the stomach and duodenum showed the most rapid increase in collagen concentration in the incision line and 40 days postoperatively both had collagen concentrations significantly greater than those of intact tissues. Wounds in the nonglandular part of the stomach only reached the level of intact tissue after 40 days. The dimensions of the biochemically active zones around incisions in stomach and duodenum remain essentially unchanged for 40 days after operation. A relation between the development of collagen concentration and mechanical strength was shown.These findings indicate that wound healing in stomach and duodenum is rapid, that collagen is the primary factor in the mechanical properties and that the highest activity is limited to a zone close to the incision line. The width of the biochemical zone remains constant.     

Comparison of ondansetron, metoclopramide and placebo as premedicants to reduce nausea and vomiting after major surgery

In a randomised, double-blind study, we have compared the incidence of postoperative nausea and vomiting in 124 patients undergoing major lower limb orthopaedic surgery following oral premedication with temazapam and ondansetron 8 mg, metoclopramide 10 mg or placebo. They received a standardised epidural and general anaesthetic. An epidural mixture containing bupivacaine 0.1% and fentanyl 10 mg.ml⁻¹ was infused postoperatively. The occurrence of nausea and vomiting was assessed every 4 h for 24 h. The incidence of vomiting significantly decreased from 55% and 43% in the placebo and metoclopramide groups, respectively, to 26% in the ondansetron group (p = 0.03). The incidence of nausea and vomiting in patients who had previously suffered was also significantly reduced from 67% and 68% in the placebo and metoclopramide groups, respectively, to 29% in the ondansetron group (p = 0.035). We conclude that oral premedication with ondansetron 8 mg was superior to metoclopramide 10 mg and placebo in preventing postoperative nausea and vomiting following major orthopaedic surgery in patients given epidural opioid analgesia.     

Prophylaxis with whole gut irrigation and antimicrobials in colorectal surgery. A prospective, randomized double-blind clinical trial

In a prospective, randomized double-blind trial, the efficacy of whole gut irrigation as preoperative bowel preparation for elective colorectal surgery was evaluated alone and in combination with two antimicrobial agents in 148 patients. The antimicrobial regimens were metronidazole alone or metronidazole and ampicillin administered systemically preoperatively and continued for 3 days. Whole gut irrigation was completed without any discomfort in 87 percent of the patients. In 3 percent, the irrigation was stopped and the patients were excluded from the study. Abdominal wound infection developed in 32 percent of the patients after whole gut irrigation, and the addition of metronidazole decreased this incidence to 22 percent (not significant). The incidence in wound infections in the group receiving metronidazole as well as ampicillin was 2 percent, and this difference was highly significant compared with both other groups. No significant difference was found for the incidence of intraabdominal abscesses (p = 0.06), infection of the perineal wound, or anastomotic leakage. No difference in the postoperative infection rate was found between a bowel containing fecal fluid or fecal masses, but when a bowel was clean, significantly fewer infectious complications were found. Whole gut irrigation is a rapid, well-tolerated, easily performed, and safe form of preoperative bowel preparation in elective colorectal surgery if combined with systemic antimicrobial prophylaxis consisting of antimicrobial agents effective against anaerobic and aerobic organisms.     

Dislocation of the superior tibiofibular joint

Derangements of the superior tibiofibular joint are divided into anterolateral, posteromedial and superior dislocations and chronic instability. Two cases of anterolateral dislocation, both needing open reduction, are presented together with a case of posteromedial dislocation.     

Histamine H2-receptor antagonists and thermal injury in rats

A study has been made of the effect of histamine H₂-receptor antagonists on thermal injury in rat bind paws produced by immersion in water at 56°C for 30 seconds. Cimetidine caused dose-dependent suppression of thermal oedema when administered before the injury, and when given after the injury also suppressed thermal oedema if given before the response was complete. Two other histamine H₂-receptor antagonists, burimamide and metiamide, had similar effects. The suppression of thermal oedema by cimetidine was due to a reduction in both the hyperaemia and increased vascular permeability to albumin caused by injury. Pretreatment with mepyramine, a histamine H₁-receptor antagonist, with the 5-hydroxytryptamine (5-HT) antagonists, methysergide and 2-bromolysergic acid diethylamide, and with the prostaglandin synthesis inhibitors, indomethacin and aspirin, did not suppress thermal oedema.     

The role of renal catecholamines in hypertension

We have found increased renal alpha 2-adrenoceptor density and a defect in prostaglandin and parathyroid stimulated adenylate cyclase in two genetic forms of rat hypertension. Changes in serum calcium and parathyroid hormone (PTH) levels suggest biologic significance to this defective adenylate cyclase response. Our hypothesis is that one or more of these defects contribute to excess renal retention of sodium and increase vascular resistance of genetically hypertensive rats and humans with essential hypertension who have similar abnormalities of calcium and PTH.     

Deliberate self-poisoning with dapsoneA case report and summary of relevant pharmacology and treatment

We report the case of a 14-year-old girl who deliberately ingested 8–9 g of dapsone and presented with severe methaemoglobinaemia and altered mental status. Prompt treatment with repeated doses of methylene blue and organ support brought about control of the methaemoglobinaemia and averted organ failure.     

Gabapentin: pharmacology and its use in pain management

Although its exact mode of action is not known, gabapentin appears to have a unique effect on voltage-dependent calcium ion channels at the postsynaptic dorsal horns and may, therefore, interrupt the series of events that possibly leads to the experience of a neuropathic pain sensation. Gabapentin is especially effective at relieving allodynia and hyperalgesia in animal models. It has been shown to be efficacious in numerous small clinical studies and case reports in a wide variety of pain syndromes. Gabapentin has been clearly demonstrated to be effective for the treatment of neuropathic pain in diabetic neuropathy and postherpetic neuralgia. This evidence, combined with its favourable side-effect profile in various patient groups (including the elderly) and lack of drug interactions, makes it an attractive agent. Therefore, gabapentin should be considered an important drug in the management of neuropathic pain syndromes.