Fifth Metacarpal Neck Fractures: Outcome-influencing Factors

Introduction Fifth metacarpal neck fractures are extremely common, but there is still no consensus regarding the ideal course of treatment.Volar angulation and shortening are decisive factors; however, there is still controversy about the cut-off values that translate into worse clinical results.The present study aims to answer these questions in order to provide additional data to aid in the clinical practice and decision making. Materials and Methods A retrospective study evaluated patients with fifth metacarpal fractures treated between 2013 and 2018. A total of 133 patients were included, with an average follow-up of 2 months. Surgery was performed in 21 patients, and 112 were treated conservatively. The radiological assessment of volar anguation and shortening was based in the first and last radiographs of the follow-up. The patients were contacted and submited to a questionnaire that included the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score and subjective evaluations of pain (Visual Analogue Scale, VAS), hand strength, stiffness and finger mobility, and cosmetic result. Results Surgery was more successful in reducing angulation than the conservative treatment, achieving more anatomic final values for angulation and shortening (p < 0.05). On the other hand, surgery seems to be associated with a higher notion of limited finger mobility (p = 0.02).Among patients treated conservatively, inicial angulations > 60° and final angulations > 50° were associated with worse cosmetic results (p = 0,039). Final shortening > 4 mm translated into a higher notion of stiffness and limited finger mobility (p = 0.034).More advanced age showed a correlation with higher scores on the VAS (p = 0.023) and QuickDASH (p < 0,001). Female patients (p = 0.02) were also associated with higher VAS scores. The overall satisfaction rate was of 97%. Conclusion Although globally the functional outcome of these fractures is very good, the present study reports several factors that should be considered when treating fifth metacarpal neck fractures.

Discomfort, pain and fatigue levels of 160 cyclists after a kinematic bike-fitting method: an experimental study

ObjectiveTo analyse rider’s subjective responses after a standardised bicycle ergonomic adjustment method.MethodsExperimental study of 160 healthy, amateur mountain bikers analysed previously and 30 days after a bike-fitting session. The main outcome measures were subjective comfort level (Feeling Scale, FEEL), fatigue (OMINI Scale) and pain (Visual Analogue Scale, VAS).ResultsAll variables demonstrated statistical significance between groups pre and post bike-fit session (p<0001). FEEL, OMNI and VAS-knee demonstrated large effect sizes (d=1.30; d=1.39 and d=0.86, respectively). VAS-hands, VAS-neck and VAS-back indicated moderate effect size (d=0.58; d=0.52 and d=0.43, respectively). VAS-groin and VAS-ankle indicated a small size effect (d=0.46 and d=0.43, respectively).ConclusionsOverall discomfort, fatigue and pain in healthy mountain biker adults improved according to all three scales. The major improvements in pain levels were detected on the knee, hands, back and neck compared with presession values. Groin and ankle pain had smaller improvements but were still significant. Future clinical trials should address the bias effects of this experimental study.

The risk of shoulder pain after laparoscopic surgery for infertility is higher in thin patients

Postlaparoscopic shoulder pain (PLSP) is a common clinical problem that needs to be addressed by medical professionals who are currently perform laparoscopic surgeries. The purpose of this study was to determine the perioperative clinical factors and demographic characteristics associated with PLSP. A prospective observational study was performed with 442 inpatients undergoing laparoscopic surgery for infertility. The pain visual analogue scale was used as the measuring instrument. To identify the predictors of PLSP, we performed multivariate conditional logistic regression. PLSP was correlated with body mass index (BMI, odds ratio = 0.815). The incidence of shoulder pain and more severe shoulder pain in patients with a lower BMI was significantly higher than it was in patients with a higher BMI, and BMI was significantly negatively correlated with PLSP. Most of the patients (95%) began to experience shoulder pain on the first postoperative day, and it rarely occurred on the day of surgery. Patients with lower BMI presented a higher risk of reporting shoulder pain on the first postoperative day. We should identify high-risk patients in advance and make specific treatment plans according to the characteristics of their symptoms.

Do standards of care and early outcomes of periprosthetic fractures change during the COVID-19 pandemic? A multicentre study

Background Periprosthetic fractures (PPFs) are a growing matter for orthopaedic surgeons, and patients with PPFs may represent a frail target in the case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The purpose of this study is to investigate whether hospital reorganisations during the most severe phase of the SARS-CoV-2 pandemic affected standards of care and early outcomes of patients treated for PPFs in Northern Italy. Materials and methods Data were retrieved from a multicentre retrospective orthopaedics and traumatology database, including 14 hospitals. The following parameters were studied: demographics, results of nasopharyngeal swabs, prevalence of coronavirus disease 2019 (COVID-19), comorbidities, general health status (EQ-5D-5L Score), frailty (Clinical Frailty Scale, CFS), pain (visual analogue scale, VAS), anaesthesiologic risk (American Society of Anaesthesiology Score, ASA Score), classification (unified classification system, UCS), type of operation and anaesthesia, in-hospital and early complications (Clavien–Dindo Classification, CDC), and length of stay (LOS). Data were analysed by means of descriptive statistics. Out of 1390 patients treated for any reason, 38 PPFs were included. Results Median age was 81 years (range 70–96 years). Twenty-three patients (60.5%) were swabbed on admission, and two of them (5.3%) tested positive; in three patients (7.9%), the diagnosis of COVID-19 was established on a clinical and radiological basis. Two more patients tested positive post-operatively, and one of them died due to COVID-19. Thirty-three patients (86.8%) presented a proximal femoral PPF. Median ASA Score was 3 (range, 1–4), median VAS score on admission was 3 (range, 0–6), median CFS was 4 (range, 1–8), median EQ-5D-5L Score was 3 in each one of the categories (range, 1–5). Twenty-three patients (60.5%) developed post-operative complications, and median CDC grade was 3 (range, 1–5). The median LOS was 12.8 days (range 2–36 days), and 21 patients (55.3%) were discharged home. Conclusions The incidence of PPFs did not seem to change during the lockdown. Patients were mainly elderly with comorbidities, and complications were frequently recorded post-operatively. Despite the difficult period for the healthcare system, hospitals were able to provide effective conventional surgical treatments for PPFs, which were not negatively influenced by the reorganisation. Continued efforts are required to optimise the treatment of these frail patients in the period of the pandemic, minimising the risk of contamination, and to limit the incidence of PPFs in the future. Level of evidence IV.

Exploration of the Clinical Effect of Modified Peroneal Nerve Block in Foot Operation Under the Plane of the Ankle joint: A Non-Randomized Clinical Feasibility Observational Study.

Background This study was aimed at exploring the clinical effect of a modified dorsal peroneal nerve block in foot operation under the ankle plane. Methods The study was observational study, thirty patients ( n =30) were observed with single-center and non-randomized. The patients were treated with an ankle nerve block (including the posterior tibial nerve, superficial peroneal nerve, saphenous nerve, and sural nerve block in the plane of the ankle) and a deep peroneal nerve block (7.5 mg/ml). The primary outcomes were intraoperative visual analogue scale score (0-10 points), numeric rating scale score (0-10 points), and Neuropen score (0-2 points). The secondary outcomes were postoperative pain visual analogue scale and numeric rating scale scores (0-10). Histograms and normal probability QQ plots were used to test the distribution of normality. Results We analyzed the data of 30 patients. It was found that after 20 min of ankle block and deep peroneal nerve block, 23 patients achieved a perfect block effect (visual analogue scale and Neuropen scores = 0), and the operation was performed smoothly. Six patients experienced slight pain (visual analogue scale score: ≤ 3, Neuropen score = 1). An intravenous sedative drip (dexmedetomidine 4 µg/ml, 1 µg/kg dexmedetomidine hydrochloride injection 2 ml:0.2 g; Jiangsu Nhwa Pharmaceutical Co., Ltd . , China) was used. The block failed in one patient, and the operation was performed under general anesthesia with a laryngeal mask in this patient. Conclusions The modified deep peroneal nerve block combined with an ankle nerve block can meet the anesthesia needs for foot surgery under the ankle plane. However, due to the limited number of patients evaluated, it is difficult to accurately predict the effect and a large degree of uncertainty exists regarding these findings. Trial registration This study had been registered at http://www.chictr.org.cn/index.aspx with No. ChiCTR2000037880 on Sep 3, 2020.It was a retrospectively registered.

Standard Multimodal Postoperative Analgesia Might Not Be Equally Effective When Comparing Anterior and Posterior Spondylodesis

Introduction. Surgical treatment of structural adolescent scoliosis, either through anterior or posterior spinal fusion, results in severe pain. Aim. In comparison with the anterior approach, the posterior approach is considered advantageous in that several spine curvatures can be corrected in a single operative act. The aim was to compare the effectiveness of a morphine-based multimodal protocol over the first 48 postoperative hours in anterior and posterior surgeries. Methods. This retrospective chart review included consecutive adolescents (10-21 years of age) treated using either the anterior (n=28) or the posterior (n=30) approach at a single hospital centre over 3 years (2015-2017). Intravenous morphine (48 mg/24 hours) was administered at hourly intervals; pain was assessed using an 11-point (higher score=worse pain) visual analogue scale on 12 occasions during the first 24 hours and on 3 occasions during the second 24 hours. Additional analgesia (non-opioid or weak opioid) was delivered on demand and/or according to medical assessment. Results. With adjustments for age and number of affected spinal segments, VAS pain scores were lower in the anterior approach, overall (48 hours) (difference = -18%, 95% CI -30 to -5), and particularly over hours 0-3 (-23%, 95% CI -36 to -7%) and hours 4-6 (-26%, 95% CI -40 to -10%) after the surgery. The rate of additional analgesic administrations was comparable throughout the observed period (rate ratios around 1.0). Conclusion. The evaluated intravenous morphinebased multimodal analgesic protocol appeared less effective in surgeries using the posterior approach, suggesting that the two approaches might require different protocols for the same level of analgesia.

Effects of the use of hyaluronic acid as compared with standard chondroprotectors therapy in patients with various degrees of gonarthrosis

Introduction. Knee osteoarthritis (gonarthrosis) of different etiology is the most common age-related joint disease affecting over 80% people beyond 55 years of age. The use of hyaluronic acid “replacement” intraarticular injections is the priority method for treating gonarthrosis. Implants with human synovial fluid containing hyaluronic acid with a concentration of 10 mg/ml are the most commonly used therapy in world practice.Objective of the study: compare the efficacy of RIPART hyaluronic acid, 3.0 ml (Ingal LLC, Russia) and the standard Mucosat chondroprotector therapy (chondroitin sodium sulfate 100 mg, Russia) in patients with degree 1–3 gonarthrosis in the outpatient setting.Materials and methods. A total of 90 patients with degree 1–3 gonarthrosis were included in the study. The patients had not previously received any treatment with Mucosat chondroprotector and RIPART hyaluronic acid. The drugs for the treatment of patients with gonarthrosis were selected in accordance with the clinical guidelines for the management of osteoarthritis, taking into account the age and comorbidity of patients. Of the non-steroidal anti-inflammatory drugs, Nimesulide, 100 mg was selected at a standard dosage of 200 mg/day for 14 days, followed by reduction of the dose to 100 mg/day for a period of 14 days to 1 month. Mucosat was used as a chondroprotector in two comparison groups No. 1 and No. 3 (n = 60) at a dose of 2.0 ml intramuscularly No. 30 ampoules every other day for 8 weeks. In comparison groups No. 2 and No. 3, a local injection of RIPART 3.0 hyaluronic acid preparation was made into the knee joint (a single injection per week, 3 in total). In comparison group No. 3 (n = 30), the patients with degree 1–3 gonarthrosis received a combined course of local therapy with RIPART 3.0 No. 3 hyaluronic acid and Mucosat injection IM.In addition to clinical examination, the time required for an individual to climb the 10-step stairs and the time required for an individual to walk the 30-m distance were used to assess the effectiveness of treatment (с). The knee joint volume was measured using a centimeter tape in the middle third of the joint, the knee range of motion was measured with electrogoniometers, the joint swelling was assessed in points (0 to 2 points), pain during palpation along the joint gap was assessed in points (0 to 2). The pain level was assessed using a visual analogue scale, and the functional WOMAC index and Leken index were determined based on the patient-reported outcomes.Results. In study group No. 1 (nimesulide + Mucosate), 30 patients with degree 1–2 gonarthrosis received nimesulide and Mucosate therapy for 6 months, which resulted in the reduction of pain on a visual-analogue scale on Days 8–9. After 6-month observation, the level of pain on the visual analogue scale in patients with degree 1–2 gonarthrosis did not exceed 20–25 mm, in patients with degree 3 gonarthrosis, the pain level on the pain visual analogue scale did not reduce less than 35–40 mm. The Leken index decreased to 2 points in degree 1–2 gonarthrosis and to 5 points in degree 3 gonarthrosis.In comparison group No. 2, the effectiveness of local RIPART hyaluronic acid therapy exceeded the indicators in group 1, which made itself evident in the fact that pain decreased on a visual-analogue scale after the first knee joint injection in patients with degree 1 and 2 gonarthrosis and resulted in a decrease of nimesulide doses on Day 2–3 followed by its cancellation. Local RIPART hyaluronic acid therapy in patients with degree 3 gonarthrosis resulted in the reduction of nimesulide dose on Day 22 after the third knee joint injection.After 6-month observation, the level of pain did not exceed 20–25 mm on the pain visual-analogue scale in patients with degree 1–2 of gonarthrosis and did not decrease less than 35–40 mm on the pain visual-analogue scale in patients with degree 3 gonarthrosis. The Leken index decreased to 5 points.In comparison group No. 3, the combined treatment “nimesulide + Mucosat + RIPART” in 30 patients with degree 1–3 gonarthrosis showed a significant and noticeable reduction in pain to 15–20 mm on the visual-analogue scale in degree 1–2 gonarthrosis and to35 mmin degree 3 gonarthrosis, the Leken index decreased to 1–2 and 5–6 points, respectively.Patients with degree 3 gonarthrosis continued to administer nimesulide at a dose of 200 mg/day for 21–23 days, followed by switching to on-demand therapy during the entire observation period (before exercise, after exercise). The pain level on the visual analogue scale in patients with degree 3 gonarthrosis decreased on day 20–23 from the baseline figures of 80–85 mm to 35–40 mm; the relapse rate of pain and reactive synovitis decreased. In patients with degree 1–2 gonarthrosis, nimesulide was cancelled on Day 8, pain level after 6 months did not exceed 15–20 mm on the visual-analogue scale. Changes in the Leken index and WOMAC index correlated with an indicator of pain level of the visual analogue scale.Conclusions. The study findings showed that the outpatient local therapy with RIPART hyaluronic acid combined with Mucosat chondroprotector and a short course of nimesulide as non-steroidal anti-inflammatory drugs may be recommenced as the preferred treatment method compared to the prescription of any of the chondroprotectors in degree 1–3 gonarthrosis.

A Randomized Study on the Efficacy of Music Therapy on Pain and Anxiety in Nasal Septal Surgery

Introduction Nasal septal surgery is one of the most common surgeries performed by otolaryngology surgeons; however, anxiety before surgery and postoperative pain remain a significant cause of morbidity. The search for a complimentary modality to reduce the symptoms and side effects has gained momentum in recent years. Objective Music therapy is an exciting and inexpensive modality in this regard, but scientific evidence in terms of randomized clinical trials is still lacking for common otolaryngology surgeries. Hence, we performed the present study. Method The sample of our study was composed of 59 patients, 30 of which were submitted to conventional medicine, while the remaining 29 were submitted to both conventional medicine and music therapy with music of their own choice, with 2 sessions per day, each lasting 30 minutes. This was performed using the generalized anxiety disorder-7 scale and the pain visual analogue scale until postoperative day 2, when the patients were discharged from the hospital. Result On comparing the anxiety and pain scores between the two groups, the group who underwent music therapy showed a statistically significant reduction in anxiety both preoperatively (p < 0.0001) and postoperatively (p < 0.0001), as well as reduced postoperative pain starting from day 0 (p < 0.001), which continued until postoperative day 2 (p < 0.001). Conclusion Music therapy is an effective adjunct in the control of anxiety and postoperative pain following nasal septal surgery.

Intra-substance steroid injection for full-thickness supraspinatus tendon rupture

Background The use of steroid injection for treatment of a full-thickness rotator cuff tear is still controversial. This study aimed to evaluate the effectiveness and safety of this treatment method. Methods Twelve patients in Group 1 received an intra-substance injection into rupture area of supraspinatus tendon with Diprospan 1 cc (betamethasone disodium phosphate 2 mg and betamethasone dipropionate 5 mg) and 1% xylocaine 1 cc. Twelve patients in Group 2 received an injection with normal saline 1 cc and 1% xylocaine 1 cc. The rupture size was measured by sonography before the injection, 3 months after the injection, and 6 months after the injection. Shoulder Pain and Disability Index (SPADI) score and Pain Visual Analogue Scale (VAS) score were measured and compared between the two groups before the injection, 1 week after the injection, 3 months after the injection, and 6 months after the injection. Results Pain and function improved more in Group 1 than in Group 2. The therapeutic effect lasted for at least 6 months in both groups. The size of the supraspinatus tendon rupture was not increased after injection in either group. Conclusions Intra-substance injection into rupture area of supraspinatus tendon with steroid and xylocaine is effective to reduce pain and improve function in patients with full-thickness supraspinatus tendon rupture without increasing the size of the rupture. Trial registration Current Controlled Trials ChiCTR1900026376, data of registration: 2019/10/05 retrospectively registered.

Effectiveness of posterior percutaneous full-endoscopic cervical foraminotomy for cervical osseous foraminal stenosis

Background To evaluate the efficacy of posterior percutaneous full-endoscopic cervical foraminotomy for cervical osseous foraminal stenosis. Methods During October 2015 to October 2018, 30 patients with skeletal cervical canal stenosis who met the selection criteria were included in the study. All patients underwent percutaneous posterior full-endoscopic nerve root canal decompression. Pain visual analogue scale (VAS) and cervical dysfunction index (NDI) were used to assess the degree of pain relief. Results All patients were followed up for 2 days to 12 months, and the final follow-up was also significantly improved after surgery, and the difference was statistically significant (P <0.05). At the last follow-up, the clinical efficacy was evaluated using the modified Macnab criteria. Conclusion Percutaneous posterior total endoscopic nerve canal incision can successfully complete the decompression of osseous neck canal stenosis. It can be used as a treatment option for patients with bony stenosis.