Comparison of intrathecal and local infiltration analgesia by morphine for pain management in total knee and hip arthroplasty: A meta-analysis of randomized controlled trial.

OBJECTIVE: We performed a meta-analysis from randomized controlled trials to evaluate the efficiency and safety between local infiltration analgesia and intrathecal morphine for pain control in total knee and hip arthroplasty. METHODS: We systemically searched electronic databases including Embase (1980-2016.7), Medline (1966-2016.7), PubMed (1966-2016.7), ScienceDirect (1985-2016.7), web of science (1950-2016.7) and Cochrane Library for relevant articles. All calculation was carried out by Stata 11.0. RESULTS: Four randomized controlled trials (RCTs) involving 242 patients met the inclusion criteria. The meta-analysis showed that there were significant differences in terms of postoperative pain scores at 24 h during rest (P = 0.008) and mobilization (P = 0.049) following total knee and hip arthroplasty. Significant difference was found regarding the incidence of nausea (P = 0.030), vomiting (P = 0.005), and pruritus (P = 0.000) between two groups. There was no significant difference between groups in terms of morphine equivalent consumption at postoperative 24 or 48 h. CONCLUSIONS: Local infiltration analgesia (LIA) provided superior analgesic effects within the first 24 h compared to intrathecal morphine (ITM) following total knee and hip arthroplasty. There were fewer adverse effects in LIA. Doses of morphine consumption were similar in the two groups.

[Comparison of the curative effect between over-elbow splint and traditional small splint fixation in the treatment of comminuted Colles fracture].

OBJECTIVE: To analyze the clinical efficacy of over-elbow small splint fixation for the treatment of comminuted Colles fractures. METHODS: From October 2013 to October 2015, 52 patients with comminuted Colles fracture were divided into two groups (the traditional splint fixation group and the over-elbow small splint fixation group) according to the treatment strategy. There were 26 patients in the over-elbow small splint fixation group including 7 males and 19 females with an average age of (64.615±11.475) years old ranging from 38 to 85 years old, and 26 patients in the traditional splint fixation group including 9 males and 17 females with an average age of (65.269±13.162) years old ranging 36 to 91 years old, respectively. In the over-elbow small splint fixation group, 3 cases were type A3 fractures, 9 cases were type C1, 7 cases were type C2 and 7 cases were type C3;in the traditional splint fixation group, 4 cases were type A3, 8 cases were type C1, 9 cases were type C2 and 5 cases were type C3. After manipulative reduction, the fractures in traditional splint fixation group were fixed with traditional small splint, and the fractures in over-elbow small splint fixation group were added with over-elbow right angle splint for the first three weeks, then continued fixing like the control group until clinical cicatrization. All patients in both groups were regularly taken X-ray examination and changed dressings to obtain the clinical healing. Patients were guided to do functional exercise after splints were taken off. The therapeutic effects were evaluated according to modified Green and O'Brein score system after 8 weeks' functional exercise. RESULTS: All patients got clinical healing without severe complications in both groups. The shortened length of radius in traditional splint fixation group was more than that in over-elbow small splint fixation group (5.923±1.978) mm VS (2.962±1.248) mm(P<0.05). There was no significant difference in radial incline between two groups. There was a higher wrist score in over-elbow small splint fixation group compared with traditional splint fixation group 89.615±11.482 vs 80.385±13.485(P<0.05). CONCLUSIONS: Over-elbow small splint fixation is better than traditional splint fixation for the treatment of comminuted Colles fracture because of reliable clinical result and excellent wrist functional recovery.

Tranexamic Acid Reduces Hidden Blood Loss in Patients Undergoing Total Knee Arthroplasty: A Comparative Study and Meta-Analysis.

BACKGROUND: To explore the efficacy of tranexamic acid (TXA) on reducing hidden blood loss (HBL) in total knee arthroplasty (TKA) by conducting a comparative study and meta-analysis. MATERIAL/METHODS: A total of 108 patients underwent TKA was equally distributed to experimental and control groups. The only difference between two groups was the administrations of 15 mg of TXA mixed in 100 mL normal saline for experimental group and 100 mL of normal saline for control group. The volumes of blood loss, red blood loss (RBL) were recorded, calculated and analyzed. Stata 12.0 software was applied for data analysis. RESULTS: The intraoperative and postoperative blood loss volume in experimental group were remarkably reduced compared with those in control group (intraoperative: 105.1±12.1 mL vs. 185.5±20.3 mL, P<0.001; postoperative: 220.7±16.8 mL vs. 290.5±22.4 mL, P<0.001). Accordingly, the control group had significantly higher transfusion rate than experimental group (3.7% vs.25.9%, P=0.001). Our results also found that both the measured and hidden RBL were obviously reduced in experimental group compared with control group (measured RBL: 96.9±11.8 mL vs. 135.2±13.5 mL, P<0.001; hidden RBL: 170.8±37.2 mL vs. 364.2±41.5 mL, P<0.001). Furthermore, meta-analysis confirmed that TXA can notably decrease HBL (SMD=2.68, 95%CI=1.55~3.80, P<0.001). CONCLUSIONS: TXA can significantly reduce the intraoperative and postoperative blood loss and HBL, therefore decreasing the transfusion need in TKA.

[Percutaneous screw fixation for the treatment of pelvic fractures under C-arm fluoroscopy].

OBJECTIVE: To investigate the applications of percutaneous screw fixation for the treatment of pelvic fractures and its related surgical considerations. METHODS: From June 2010 to June 2012,19 patients with pelvic fractures were treated with percutaneous hollow screws. There were 13 males and 6 females, with an average age of 41 years (ranged from 22 to 58 years). Fractures were caused by traffic accidents in 11 cases, by falling down from high place in 8 cases. Based on the Tile classification, there were 15 cases of Tile C type and 4 case of Tile B type. The indexes such as screw inserting time, intraoperative blood loss, complications, functional recovery and reduction conditions were observed. Fixation methods included sacroiliac screws, cannulated screw fixation of the pubic ramus and cannulated screw fixation of the pubic symphysis separation. RESULTS: Anatomical reduction achieved in 7 cases, satisfactory reduction 11 cases, and unsatisfactory reduction 1 case. Union time of fracture union ranged from 8 to 12 weeks (mean 10 weeks). Wound infection,ununion of fracture and nerve injuries were not found. According to the Majeed standards, 12 patients obtained an excellent results, 6 good and 1 fair. CONCLUSION: Percutaneous screw fixation for the treatment of pelvic fractures under fluoroscopy has several advantages such as less trauma, less blood loss, fewer rates of complications, reliable fixation and no blood transfusion, which can reconstruct the stability of the pelvic ring, but it needs adequate preoperative preparation and high requirements for the surgeon.

[Case-control study on small splint fixation with trapezoid pad and plaster slab fixation for the treatment of comminuted Colles fracture].

OBJECTIVE: To compare the clinical efficacy of trapezoid pad coordinate with small splint fixation treatment with plaster slab fixation treatment for comminuted Colles fracture. METHODS: From October 2010 to March 2012,80 outpatients with comminuted Colles fracture were divided into two groups. There were 40 patients in trapezoid pad splint fixation treatment group and 40 patients in pipe type plaster control group. There were 13 males and 27 females in trapezoid pad splint fixation treatment group,with an average age of (62.1 +/- 19.2) years old. And there were 15 males and 25 females in pipe type plaster control group,with an average age of (60.2 +/- 19.5) years old. After treated with manipulative reduction,the fractures were fixed with pipe plaster in the control group, and were fixed with trapezoid pad joint by small splint in the treatment group. The patients in both groups were regularly taken X-ray recheck and changed dressings to obtain the clinical healing. Patients were guided to do functional exercise after splints were taken off. The therapeutic effects were evaluated according to Gartland-Werlley wrist score when splints taken off and after 2 months. RESULTS: According to wrist score, the average scores in the treatment group were (8.1 +/- 2.8) when splints taken off and (5.3 +/- 4.5) after 2 months. And the average scores in the control group were (10.3 +/- 2.6) when splints taken off and (8.4 +/- 5.8) after 2 months. The score in the treatment group was higher than that of control group. The average shortened lengths of radius were (4.8 + 1.7) mm in the treatment group and (8.2 +/- 2.1) mm in the control group. The shortened length of control group was larger than that of treatment group. CONCLUSION: Trapezoid pad coordinated with small splint fixation is better than traditional pipe type plaster for treating comminuted Colles fracture.

[A medium-term analysis on of therapeutic effects of locking proximal humerus plate for the treatment of comminuted fractures of proximal humerus].

OBJECTIVE: To investigate the medium-term curative effects of locking proximal humerus plate for the treatment of comminuted fractures of proximal humerus, and provide evidences for the clinical practice. METHODS: From August 2005 and April 2008, 23 patients with comminuted fractures of proximal humerus were treated with locking plates, including 12 males and 11 females, aged 27 to 76 years old (averaged 51.5 years old). There were 18 cases of traffic accident injuries, 4 cases of falls injuries, and 1 case injured after heavy pressure. According to Neer classification, 11 cases were three-part fractures, and 12 cases were four-part fractures. Outcomes were assessed with radiography and the Constant-Murley (C-M) shoulder evaluation. RESULTS: All the patients got primary healing of incisions. Twenty-three patients were followed up, and the duration ranged from 17 to 49 months, with an average of 35.25 months. Twenty patients had fracture healing during 4 to 7 months after operation. There was no significant differences among 3, 6 and 12 months after operation in C-M scoring. The average C-M score was (79.85 +/- 17.23) points (38 to 100 points) at the 12th month after operation, 8 cases got an excellent result, 8 good, 5 fair, and 2 poor. In the LPHP plus bone graft group 6 cases got an excellent result, 4 good, 3 fair, and 1 poor; in LPHP fixation group 2 excellent, 4 good, 2 fair,and 1 poor. CONCLUSION: The medium-term curative effect of the locking proximal humerus plate in the treatment of proximal humeral fractures is significant. For the comminuted fractures of proximal humerus combined with osteoporosis and bone defects, bone graft should be performed routinely.

[To compare and research the clinical effect of treating the comminute distal radius fractures by refining splintage].

OBJECTIVE: To treat the comminute distal radius fractures by improved splint, and obersve the curative effect and compare the radiology with the traditional splint. METHODS: Ninety-two patients with distal radius comminute fracture were randomly divided into two groups. There were 38 males and 54 females. The average age was 63 years old ranging from 23 to 82. Acording to AO classification on the distal fracture of the radius, there were 15 cases of A3, 40 cases of C1, 26 cases of C2 and 11 cases of C3. After all patients were treated by manipulative reduction, 46 cases of the treatment group were fixed supra-carpometacarpal joints by improved splint and trapezoid pad, the other 46 cases of control group were treated with the traditional spilint. Both groups were regularly taken X-ray recheck and changed dressings to obtain the clinical cicatrization. Patients were guided to do functional exercise after splints were taken off. Six weeks later all patients were evaluated the curative and radiologic effect according to Gartland-Werlley wrist score and Lidstrom grade respectively. RESULTS: According to wrist score,there were 13 cases on excellent, 34 cases on fine and 9 cases on normal in treatment group, which average score was (4.0 +/- 2.6) and the percent of wrist functional fitness was 80.6%. There were 9 cases on excellen, 19 cases on fine and 18 cases on normal in control group, which average score was (6.0 +/- 4.2) and the percent of wrist grad and 4 cases on the third grade in treatment group. There were 22 cases on the first grade, 16 cases on the second grad and 8 cases on the third grade in control group. CONCLUSION: The outcome of improved splint was better than that of traditional splint on the function and radiology for treating the comminute distal radius fracture.