Limb Fractures Research Articles

Horse and Cattle-Related Trauma: A Retrospective Review of Injuries and Management in a Regional Queensland Hospital.

Horse and cattle-related trauma is a common presentation to regional hospitals in Australia. We review local incidence and patterns of injuries relating to horse and cattle trauma over a three-year period at the Toowoomba Base Hospital within the Darling Downs region in Queensland, an area rich in cattle farming and equestrian recreation. We conducted a single-centre retrospective cohort study. The inclusion criteria were all patients presenting with injuries following cattle or horse-related incidents between January 2018 and April 2021. Primary outcomes were the mechanism of trauma, confirmed injuries, and the need for admission, operative intervention, or inter-hospital transfer. A total of 1002 individuals (55% female; mean age 34 years; median Injury Severity Score (ISS) 2) were identified during the study period. Presentations relating to horses (81%) were more frequent than cattle (19%). The most common mechanism of injury was "falling" for horse incidents (68%)and "trampling" for cattle incidents (40%). Horse incidents often resulted in soft tissue injury (55%), upper limb fracture (19%), or lower limb fracture (9%). Cattle incidents often resulted in soft tissue injury (57%), upper limb fracture (15%), and rib fracture (15%). Overall, 14% required admission, 13% required operative intervention, and 1% required inter-hospital transfer. This local series demonstrates a high volume of cattle and horse-related trauma in our region. Whilst most patients are managed locally without operative intervention, the high frequency of injuries observed necessitates further development of preventative measures and safety advocacy.

Locking Reconstruction Plate for the Management of Diaphyseal Femoral Fracture in a Dog

Fracture of the long bone is a commonly encountered orthopaedic problem in canine practice (Aithal et al.,1999). Femur fractures are one of the most common orthopaedic affections encountered in dogs comprising 35 % of hind limb fractures and 24 %of all fractures in dogs (Johnson et al., 1998). Proximal and distal epiphyseal fractures happen in young animals, whereas diaphyseal and metaphyseal fractures are more frequent in older animals(Guiot et al., 2012, Abd El Raouf, 2017). They are difficult to repair due to the fact that such dogs are recumbent and need early rehabilitation to establish speedy recovery. The closeness of the abdominal wall to the proximal femur and surrounding heavy muscles limits the use of coaptation and external skeletal fixation for femoral fractures.

Fractures of the limbs: basic concepts for the emergency department

Traumatic injuries of the limbs are very common and account for a large number of imaging examinations, especially in emergency departments. These injuries can often be resolved if they are recognized and treated appropriately. Their diagnosis requires a complete clinical assessment and the correct interpretation of the appropriate imaging tests. Radiologists play an important role, especially in diagnosing lesions that can go undetected. To this end, radiologists need to know the normal anatomy and its variants, the mechanisms of injury, and the indications for different imaging tests, among which plain-film X-rays are the main technique for the initial evaluation. This article aims to review the relevant characteristics of limb fractures in adults and of lesions that can be associated with these fractures, as well as how to describe them to ensure appropriate clinical management.

Impact of urinary calcium excretion on kidney, bone, and cardiovascular systems in patients with bone biopsy proven osteoporosis: a longitudinal long-term follow-up study.

Hypercalciuria is common in patients with osteoporosis. However, the long-term effect of urinary calcium excretion (UCaE) on patients' health is not well-examined. The current study aims to assess the impact of UCaE on kidney, bone, and cardiovascular outcomes in patients with bone biopsy proven osteoporosis. Longitudinal study of all patients with osteoporosis who underwent bone biopsy and 24-h urine collection between 2008 and 2015 in the University of Kentucky. DXA scans, serum markers, kidney function, and cardiovascular events were recorded until last clinic visit in 2021. Exclusion criteria were secondary osteoporosis or conditions that might substantially impact UCaE. The significant results in univariate analysis were confirmed in multi-variable regression models involving clinically important covariates that might impact patients' outcomes. Study included 230 patients with mean follow-up of 7.2 ± 2.9 years. The mean age was 61 years, and the mean eGFR at baseline was 85 ± 19 ml/min/1.73 m2. Low bone turnover (LBT) was present in 57% and high bone turnover (HBT) in 43% of patients. Hypercalciuria was found in one-third of patients with no difference between LTB and HTB. UCaE correlated positively with eGFR but did not affect the rate of eGFR decline over time. Higher UCaE predicted kidney stones development. We observed U-shaped effect of UCaE on bone health. Hypercalciuria predicted loss of BMD at all sites, but also hypocalciuria was associated with higher loss in total hip BMD. Upper limb fractures were the most observed fractures, and their incidence was higher in patients with hyper- or hypo-calciuria. Lower UCaE independently predicted development of major adverse cardiac events (MACE) and cardiovascular disease (CVD). UCaE correlated with eGFR but it did not affect the change of eGFR over time. Patients with normal UCaE had lower incidence of upper limb fractures and less reduction in BMD. Low UCaE predicted MACE and CVD.

Fracture rates by medication type in attention-deficit/hyperactive disorder.

ADHD is a condition with extensively researched increased risks of psychiatric disorders, traumatic injury, impulsivity, and delayed response times. To analyze the incidences of fractures in patients with ADHD on various medication regimens. Using the TriNetX database, we created seven patient cohorts, all of age under 25, based on medication types commonly used for ADHD. The cohorts we created were: no medication use, exclusive use of a -phenidate class stimulant, exclusive use of an amphetamine class stimulant, nonexclusive use of formations of either stimulant, exclusive use of non-stimulant medications approved for ADHD, nonexclusive use, and no medications. We then examined rates while controlling for age, sex, race, and ethnicity. The comparison of ADHD to neurotypical individuals revealed an increased risk for all fracture types. For the controlled analysis, all but one cohort had significant differences in each fracture type compared to the baseline cohort of ADHD patients without any medication use. Patients in the "phenidate" cohort had an insignificant difference in risk of lower limb fractures. Patients in the "any medication," "-etamine," "stimulant," and "not ADHD" groups all had significant decreased risks for all fracture types, with confidence intervals often overlapping between treatment modalities. As patients experiment with different medication regimens, providers should be aware of the difference in risk of fracture by medication type. Our results highlight the need for continued research to better discern appropriate medication regimens with the goal of improving overall risk reduction and producing better outcomes for individuals with ADHD.

A Prospective Epidemiological Survey of Paediatric Trauma in Africa: A Cross-Sectional Study.

Trauma is a leading cause of morbidity and mortality in children worldwide. There is a need for development and provision of efficient paediatric trauma services based on adequate information and funding which are lacking in low- and middle-income countries. This study was carried out to assess the scale of the problem, identify the most common causes of trauma in Pan African Paediatric Surgical Association (PAPSA) zone and to define the limiting factors for provision of the necessary services required to reduce the potential mortality and disability. Data were collected through an electronic form sent out in PAPSA platform. Members were requested to provide prospective data on all paediatric major trauma admitted to or seen at their health facilities between the beginning of April 2019 and the end of June 2020. Hospital location, child's age, gender, type of injury, mechanism of injury, severity, initial management, method of transport, time to arrive to hospital, availability of surgical specialities, length of hospital stay and injury outcome were analysed. There were 531 entries. The mean age was 3.53 years and median age 1.34 years. Male-to-female ratio was 2:1. The leading causes for injuries were falls 194 (36.53%) and motor vehicle crashes (MVCs) 176 (33.15%) followed by obstetrical 42 (7.9%), thermal 27 (5.1%) and domestic injuries 22 (4.1%). The most common injuries were limb fractures 181 (34.1%) and traumatic brain injury 111 (20.9%). Public and private transport were used in 313 (58.9%), while ambulance service was used in only 54 (10.1%). Distances to a health facility varied between 1 and 157 km. 70.2% of cases did not receive any primary care, while definitive care was received in 95.5% of the cases. Outcome was full recovery in 90.6% of patients, morbidity in 8.1% and a mortality rate of 1.3%. Most of the injuries were in the under 5-year age group. The two main causes of trauma in children in this study were the falls from height and MVCs. Long distance travels to reach health-care facilities were noticeable in this study, together with substantial lack of adequate ambulance facilities and shortage in necessary subspecialty services such as neurosurgical, orthopaedics and rehabilitation. Implementing proposed recommendations can reduce the burden.

What outcomes have been reported on patients following open lower limb fracture, and how have they been measured?

Open lower limb fracture is a life-changing injury affecting 11.5 per 100,000 adults each year, and causes significant morbidity and resource demand on trauma infrastructures. This study aims to identify what, and how, outcomes have been reported for people following open lower limb fracture over ten years. Systematic literature searches identified all clinical studies reporting outcomes for adults following open lower limb fracture between January 2009 and July 2019. All outcomes and outcome measurement instruments were extracted verbatim. An iterative process was used to group outcome terms under standardized outcome headings categorized using an outcome taxonomy. A total of 532 eligible studies were identified, reporting 1,803 outcomes with 786 unique outcome terms, which collapsed to 82 standardized outcome headings. Overall 479 individual outcome measurement instruments were identified, including 298 outcome definitions, 27 patient- and 18 clinician-reported outcome measures, and six physical performance measures. The most-reported outcome was 'bone union/healing' reported in over 50% of included studies, while health-related quality of life was only measured in 6% of included studies. Outcomes reported for people recovering from open lower limb fracture are heterogeneous, liable to outcome reporting bias, and vary widely in the definitions and the measurement tools used to collect them. Outcomes likely to be important to patients, such as quality of life and measures of physical functioning, have been neglected. This systematic review identifies the need to unify outcome measures reported on patients recovering from open lower limb fracture; this may be addressed by creating a core outcome set.

Facial blast injuries in gold panning: Epidemiological and clinical patterns

ObjectiveFacial blast injuries in gold panning are rarely reported in the literature. The aim of this paper is to describe the epidemiological and clinical presentations of facial blast injuries in gold panning in Burkina Faso. MethodsThe medical records of patients suffering from facial blast injuries in gold panning sites between January 2017 and December 2020 were analyzed retrospectively. Data recording and analysis were performed with Epi Info 7 software. ResultsFacial blast injuries in gold panning represented 3.1 % of all facial trauma. The patients were all male with a mean age of 26.8 years. Soft tissue injuries accounted for 44.2 % of facial injuries. Two-thirds of the wounds were skin screening. Facial fractures accounted for 23 % of injuries. They were a multiple fracture in 4 patients. Monocular and binocular blindness were observed with equal frequency, each in 7 patients. Associated injuries were hand dislocations in 31 patients, thoracic limbs fractures in 5 patients, lower limbs fractures in 6 patients and perforation of the eardrum in 1 patient. ConclusionThese results call for a strengthening of the laws governing the use of explosives, and a rigorous supervision of artisanal gold panning in Burkina Faso.

THE EFFECT OF SPIRITUAL EMOTIONAL FREEDOM TECHNIQUE (SEFT) ON ANXIETY AND PAIN IN POST-OPERATIVE FRACTURE PATIENT

Postoperative fracture patients can experience anxiety and pain which impact on the healing process because it affects physiological and psychological conditions. Several studies have revealed that this condition can be treated with Spiritual Emotional Freedom Technique (SEFT) therapy because it can eliminate negative emotions. However, the impact on pain and anxiety in postoperative fracture patients who are hospitalized is not yet known. The purpose of this study was to determine the effect of SEFT therapy on reducing anxiety and pain in postoperative fracture patients at dr. Zainoel Abidin (RSUDZA) Banda Aceh. The research method used was quasi-experimental through a post test only control group design by means of randomization of the control and experimental groups, providing educational interventions on SEFT management and post tests on 44 respondents who were divided into the intervention group and the control group. The independent t-test technique obtained p-value of 0.032 (<0.05) and the Man Whitney U test obtained p-value of 0.008 (<0.05 so there is a difference between the control group and the control group intervention after being given SEFT therapy. it turns out that the respondent is able to focus attention so as not to experience anxiety which can increase his perception of pain, so that the pain scale decreases. There is a significant effect of SEFT therapy on anxiety and pain in postoperative limb fracture patients. These results are expected to add to the reference to help meet the psychological needs of postoperative fracture patients with pain and anxiety.

Adverse events are not increased by controlled delay in surgery of acute upper extremity fractures

Management of the operative treatment of fractures is challenged by daily variation in patient flow. For upper limb fractures there has recently been an increasing tendency to temporarily discharge the patient to wait for a daytime operation to be performed during the next few days. The objective of this study was to study the safety of controlled delay in surgery. Upper limb fractures (N = 1 944) treated in a level 2 trauma center from 2010 to 2016 were identified and included in this retrospective cohort study with 5-year follow-up. Delay in surgery, inpatient time, readmissions, ED revisits and mortality were analyzed. Depending on the nature of the injury, controlled delay to surgery was implemented. Urgency of surgery was coded as green (2 days to 2 weeks) yellow (8–48 h) or red (less than 8 h). Harms and benefits to the groups were compared. Controlled delay of surgery (median delay of 5 days 7 h) was applied in 1 074 out of 1 944 fractures. The number of revisits to the emergency department (11.1% vs. 17.9–24.1%, p < 0.001) or hospital readmissions for any reason (0.99 per 100 person years in the delayed group vs. 3.74 and 4.35 in the non-delayed groups, p < 0.001) was no higher in patients with delayed (green) compared to those with non-delayed (yellow and red) operations. Inpatient time was significantly lower in the delayed group than other groups (IRR 2.31–3.36, (p < 0.001)). The standardized mortality ratio was 0.83 (CI 0.57–1.22) in the delayed group vs. 1.49 (CI 1.17–1.90) and 1.61 (CI 1.16–2.23) in the non-delayed groups. Controlled delay in upper limb trauma surgery did not lead to increased readmissions or mortality and was associated with reduced inpatient time.

Admission lactate concentration has predictive value for death or severe complications within 30 days after admission in cattle with long-bone fractures.

To determine the prognostic value of lactate concentration measurements at admission in cattle with long-bone fractures. 43 cattle with long-bone fractures between July 2016 and Dec 2018. In this prospective cohort study, lactate concentration was measured in systemic venous blood and locally in capillary blood sampled from the fractured and contralateral limbs of cattle and assessed for outcome prediction. The cutoff value was determined by maximizing the Youden index from receiver-operating characteristic curves. Multivariable logistic regression was employed to verify whether higher lactate concentrations compared with the cutoff value were an independent risk factor for poor outcomes at 30 days or 3 years after admission. Poor outcome was associated with higher capillary lactate concentration in the fractured limb (P < .001) and greater difference with systemic blood (P = .005). A cutoff value of lactate difference ≥ 2.4 mmol/L (sensitivity = 0.80; specificity = 0.965) between capillary lactate in the fractured limb and systemic blood was the best predictor of death ≤ 30 days after admission (P < .001). Multivariable analysis revealed that this cutoff value was an independent risk factor for 30-day and 3-year outcomes (P < .001). Admission blood lactate concentration difference ≥ 2.4 mmol/L between the fractured limb and systemic blood was a robust and independent predictor of outcome for cattle of the present report. Lactate metabolism is locally impaired in fractured limbs of nonsurviving or at higher complication risk cattle, which may help identify patients at high risk for poor outcomes.

FRACTURES, DISLOCATIONS, AND TENDON RUPTURES IN FEMALE VERSUS MALE AUSTRALIAN FOOTBALLERS: A PROSPECTIVE STUDY OF EMERGENCY DEPARTMENT PRESENTATIONS

Australian Football (AF) is a popular sport in Australia, with females now representing one-third of participants. Despite this, the injury profiles of females versus males in largely unknown. The current study investigated fractures, dislocations and tendon ruptures in females versus males presenting to emergency departments (ED) with an AF injury.All patients, regardless of age, presenting to one of 10 EDs in Victoria, Australia, with an AF injury were included. Data were prospectively collected over a 10-month period, coinciding with a complete AF season. Data were extracted from patient medical records regarding injury-type, body-part injured and treatments required. Female and male data were compared with chi-squared tests.Of the 1635 patients presenting with an AF injury, 595 (36.0%) had a fracture, dislocation or tendon rupture, of whom 85 (14.3%) were female and the average age was 20.5 years (SD 8.0). Fractures accounted for most injuries (n=478, 80.3% of patients had a fracture), followed by dislocations (n=118, 19.8%) and tendon ruptures (n=14, 2.4%). Upper limb fractures were more common than lower limb fractures (71.1% v 11.5% of fractures). Females were more likely to fracture their hands or fingers than males (45.7% v 34.3%). Males were more likely to fracture ribs (5.4% v 0%). Most fractures (91.2%) were managed in the ED, with the remainder being admitted for surgery (GAMP/ORIF). Males were more likely to be admitted for surgery than females (11.2% v 5.9%). Regarding dislocations (n=118), females were more likely to dislocate the patella (36.8% v 8.1% of dislocations). Only males sustained a tendon rupture (n=14): finger extensor or flexor (57.1%), achilles tendon (28.6%) and patella tendon (14.3%).Orthopaedic AF injuries are common presentations to EDs in Victoria, though few require specialist orthopaedic intervention. Injury profiles differed between genders suggesting that gender specific injury prevention and management might be required.

Antibiotic-Loaded Coatings to Reduce Fracture-Related Infections: Retrospective Case Series of Patients with Increased Infectious Risk.

Local antibiotic delivery strategies have been increasingly employed for the prevention of fracture-related infections (FRIs). The aim of this study is to evaluate the efficacy and safety of antibiotic-coated implants in the prevention of FRIs after surgical treatment in patients with increased infectious risk. A retrospective observational study has been conducted on patients with upper and lower limb fractures treated with internal fixation or prosthetic replacements, using a gentamicin coated nail (CN) and/or antibiotic-loaded hydrogel applied to the implant of choice (ALH). The study included 37 patients (20 M, 17 F), with a mean age of 63 years. The mean estimated preoperative infectious risk score was 6.4%. ALH was used in 27 cases, tibial CNs were implanted in 4 cases, and both were employed in 6 cases. The antibiotics used locally were gentamicin in 72.97% of cases (27 patients) and a combination of gentamicin + vancomycin in 27.03% of cases (10 patients). Mean follow-up was 32 months. Only one case (2.94%) showed onset of FRI at 5 months after surgery. Local antibiotic prophylaxis by coating resulted in a reduction in the incidence FRI, as compared to the estimated preoperative risk. The use of ALH allows for the choice of antibiotic; however, the application of antibiotics seems more nonuniform when applied to a nail.

Treatment of congenital atypical haemangiosarcoma in a foal

SummaryHaemangiosarcoma is a rare vascular tumour in horses, usually originating from blood vessel endothelial cells. We present the case of an 8‐day‐old foal, referred for an atypical large subcutaneous mass on the left side since birth. Ultrasonographically, it showed multiple cavities with hypoechoic content, marked vascularisation and fluid movement between cavities. As the nature of the mass suggested that surgery could result in profuse bleeding, we decided to perform an initial arteriography to identify the pattern and calibre of the main vessels and embolisation of this vascular supply, which allowed surgical removal with less bleeding than expected. This approach, with pre‐surgical transarterial embolisation of the tumour, is not commonly used in equine surgery. Histology established a diagnosis of cutaneous haemangiosarcoma. During 1‐year post‐surgery, clinical and ultrasound examinations were carried out without any signs of recurrence or metastasis. One year later, the foal was euthanised due to a limb fracture. No macroscopic signs of metastasis were observed at necropsy. Histology showed no signs of recurrence. Cutaneous haemangiosarcomas, though rare, should be included in the differential of masses and growths with compatible ultrasound or cytological findings. Transcatheter arterial embolisation of highly vascularised neoplasms can reduce bleeding and facilitate subsequent surgical resection.

A case report: extracorporeal membrane oxygenation for multitrauma patient with pneumorrhagia

BackgroundExtracorporeal membrane oxygenation (ECMO) can be used as salvage therapy for multitrauma patients with acute respiratory distress syndrome (ARDS) when conventional treatment fails to maintain oxygenation. However, controversy exists between ECMO application and the risk of bleeding due to systemic anticoagulation during the treatment. Non-heparin introduction seems to be a possible solution for this dilemma, owing to technical improvements in the device and management methods of ECMO.Case presentationA 58-year-old woman suffered from blunt thoracic, pelvic, and right lower limb fractures due to a falling accident, which resulted in acute respiratory distress syndrome (ARDS). Although the patient received intubation and mechanical ventilation (MV), respiratory failure was not alleviated. Venous-venous (V-V) ECMO was used as a salvage therapy. With the support of V-V ECMO, we safely cleared blood clots in the bronchus and avoided secondary lung injury caused by pressure trauma and oxygen poisoning of the MV. We introduced heparin-free ECMO management as a solution to reduce the risk of bleeding associated with pulmonary contusion and other organ injuries. To prevent thrombosis, we set the blood rate of ECMO to 4.0 L/min, which is much higher than the usual parameter. During ECMO, coagulation factors, such as prothrombin time, activated partial thromboplastin time, and D-dimer, were examined. ECMO was maintained for 5 days without any complications; MV was stopped on the 13th day, extubated on the 24th day, and discharged from ICU on the 28th day.ConclusionECMO with non-heparin could be an optimal treatment for multitrauma patients with ARDS when traditional treatment cannot sustain oxygenation. High blood flow rate could prevent thrombosis through ongoing ECMO therapy without systemic anticoagulation. In addition, monitoring D-dimer value change (Δ D-dimer) may be better than D-dimer value in predicting clot formation in the membrane oxygenator.

Bifidobacterium longum supplementation improves age-related delays in fracture repair.

Age-related delays in bone repair remains an important clinical issue that can prolong pain and suffering. It is now well established that inflammation increases with aging and that this exacerbated inflammatory response can influence skeletal regeneration. Recently, simple dietary supplementation with beneficial probiotic bacteria has been shown to influence fracture repair in young mice. However, the contribution of the gut microbiota to age-related impairments in fracture healing remains unknown. Here, we sought to determine whether supplementation with a single beneficial probiotic species, Bifidobacterium longum (B.longum), would promote fracture repair in aged (18-month-old) female mice. We found that B.longum supplementation accelerated bony callus formation which improved mechanical properties of the fractured limb. We attribute these pro-regenerative effects of B.longum to preservation of intestinal barrier, dampened systemic inflammation, and maintenance of the microbiota community structure. Moreover, B.longum attenuated many of the fracture-induced systemic pathologies. Our study provides evidence that targeting the gut microbiota using simple dietary approaches can improve fracture healing outcomes and minimize systemic pathologies in the context of aging.

Design and Simulation Analysis of Robot-Assisted Plate Internal Fixation Device for Lower Limb Fractures

Abstract: Internal fixation with steel plates is a common method for the therapy of lower limb fractures. Due to the disadvantages of traditional surgical methods such as high trauma and complications, the application of robots for minimally invasive surgery has become a popular research direction. In this article, we have designed and simulated the overall structure of a steel plate internal fixation device used in conjunction with a robotic arm. Firstly, a finite element model of cortical bone drilling was established based on ABAQUS to obtain the torque and axial force when drilling the cortical bone. Then a virtual prototype of the robot-assisted lower limb bone fracture plate internal fixation device was designed, and the outer shell, drilling mechanism, nail placement mechanism, nail supply mechanism, drive mechanism, and guide sleeve were refined based on the overall mechanical structure of the device, so that the device could continuously perform drilling and nail placement. Afterward, the device was simulated based on ADAMS, and the motion curves of each component were obtained to verify the feasibility of the device’s working principle and to validate the performance of the servo. Finally, the modal analysis of the device was carried out with the finite element software ABAQUS, and the modal parameters of the first six orders were obtained, which were compared with the operating frequencies of the motor and the servo to verify that the device is not easy to resonate during normal operation, and the static strength checks of the key components were carried out, and the stress and deformation clouds and upper limits of flexural values of the components were obtained, which proved that the structure has stability.

Influence of Different Sevoflurane Concentrations on Postoperative Cognitive Function in Aged Rats.

Postoperative cognitive dysfunction may be associated with neuroinflammation, and sevoflurane suppresses surgery-induced inflammation. We hypothesized that low concentrations of sevoflurane would result in more impaired postoperative cognitive function compared to high concentrations. Aged male Sprague-Dawley rats (n = 21, 17-22 months) were randomly assigned to 1 of 3 groups: control (C), sevoflurane 2% (S2), and sevoflurane 4% (S4). Rats in the S2 and S4 groups underwent open femoral fracture and intramedullary fixation of the left hind limb under 2 hours of sevoflurane anesthesia. Neurological outcomes were evaluated using the Morris water maze (MWM) test, and histopathological outcomes were assessed 28 days after surgery. The S2 group showed prolonged swimming latency compared to S4 on day 7 (difference of means, 34.4; 95% confidence interval [CI], 2.57-66.3; P = .031) and compared to the C group on day 9 (difference of means, -33.4; 95% CI, -65.3 to -1.55; P = .037). The intact CA1 cells in the S2 group were significantly less than those in the C and S4 groups (H statistic, 10.87; P = .006 versus C; P = .033 versus S4). We found that low concentrations of sevoflurane prolonged the swimming latency of the MWM compared to high concentrations and reduced intact CA1 hippocampal neurons in aged rats. These results suggest that low-concentration sevoflurane anesthesia may be more detrimental than high concentration for spatial cognitive function and postoperative impairment of hippocampal CA1 cells in aged rats.

Effect of Preemptive Multimodal Analgesia Regimen on Post-operative Epidural Demand Boluses in Lower Limb Orthopaedic Surgeries.

Introduction Excruciating pain is associated with lower limb orthopaedic surgeries involving femoral shaft fractures. Postoperative pain management is still ineffective in low-resource settings where the use of epidural and opioid-free analgesia is impractical. Literature is scarce with respect to the effect of a preemptive multimodal analgesia regimen on the requirement of postoperative epidural demand boluses.Hence, the present study aimed to evaluate the effectof pre-emptive multimodal analgesia in reducing the requirement of epidural demand boluses postoperatively, and to find out the time required to receive the first epidural bolus. Material and methods This double-blinded randomized control study included 48 subjects. Patients aged 18-60 years with lower limb fractures requiring surgery under combined spinal-epidural anesthesia were included. Patients were divided into two groups through random allocation. Group A: Preemptive multimodal group received intravenous paracetamol 1 g, IV diclofenac 75 mg diluted in 100ml NS, IV tramadol 50mg diluted in 100ml NS and tab pregabalin 75 mg orally, 30 mins before surgery. Group B:Placebo group received 3 pints of 100ml NS IV and tab ranitidine 150 mg, 30 mins before surgery. Intraoperatively, combined spinal-epidural anaesthesia was administered taking all theaseptic precautions. Visual analogue scale (VAS) was recorded immediately on shifting to a postoperative room, and then at 1, 4, 8, 12, and 24 hr for both groups. Epidural boluses (10 ml of 0.125% bupivacaine with 2 μg/ml of fentanyl) were given whenever the patient's visual analogue scale was more than 4. The time at which the first epidural bolus was required by the patient was recorded. The total number of epidural boluses given over 24 hours based on VAS was recorded for both, the preemptive and placebo groups. If the patient still complained of pain, IV diclofenac 75 mg was given if the VAS was more than 4, while IV diclofenac 75 mg along with IV tramadol 50 mg was given if the VAS was more than 6. Patient satisfaction with anesthesia care, in general, was assessed 24 hrs postoperatively. Results A total of 48 subjects were included in the study. During the immediate-postoperative period, and at 8, 12 and 24 hr, the median VASwas significantly low in group A as compared to group B. A significant increase in the demand for epidural bolusimmediate-postoperatively was observed in group B (70.83%) compared to group A (4.17%) (p-value of <0.001).At 8 hr, 12hr, and 24hr, patients in group A found a significantly less need for epidural boluses compared to Group B. The mean total number of epidural boluses taken in group A was significantly less compared to group B (1.79 ± 0.41 VS 3.33 ± 0.48, p-Value <0.001). In group A, all patients reported no requirement for diclofenac and tramadol. In group B, 8.33% required diclofenac 75 mg, while the remaining 91.66% had no requirement for diclofenac and tramadol. The difference in patient satisfaction with anaesthesia care in general between the two study groups was found to be significant with a p-value of 0.027. Patients in Group A were very satisfied compared with those in group B. Conclusions The study found that the pre-emptive multimodal analgesia group had better postoperative pain control because they required fewer epidural boluses and no extra analgesics postoperatively. This group was more satisfied with the anaesthesia care in general.

Intramuscular Pressure following Compartment of Limbs by Electric Measuring Instrument of Tissue Pressure

Background and Aim: Muscular compartment syndrome that is surgical disease at high risk of morbidity and disability causes intra-compartment bleeding as injury of muscle tissue with fracture and luxation in limbs. Increasing pressure of compartment makes small veins exhausted and migration of humor difficult in that compartment, finally it causes arterial ischemic block of blood circulation and muscular necrosis by increasing tissue pressure that is just opposite of systolic pressure. That is why it is really important to diagnose and treat this disease earlier than irreversible ischemic changes, so we can reduce permanent disability. Methods: We used electric measuring instrument of tissue pressure and obtained some basic results to diagnose those disease that causes increasing disability earlier by measuring intramuscular pressure following compartment in healthy people and patients with closed fracture in their limbs. Results and Conclusion: The difference between every muscles following compartment, sex, age in healthy people was not statistically significant and difference between sports men and officers or workers reached statistical significance. Intramuscular pressure in fracture region of patients with closed fracture in limbs was statistically significant than normal region of them.