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Background and Aim: One of the leading reasons that patients, particularly older persons, are brought to the orthopedic emergency room is a fracture at the end of the radius. In this study, a new traction method for distal radius fractures was compared with manual reduction. Methods: The census method was used in this clinical trial to study 45 patients (46 hands) who were referred to Hamedan Besat Hospital in 2021. Patients were randomly assigned to two groups. The manual reduction (pressure and traction by an assistant and a doctor) method was implemented in Group A, and the new traction procedure (pressure and traction by hardware or a device) was performed in Group B. The radiographic results of reduction in both groups were investigated and compared immediately and in the first and 6 weeks after surgery. Results: The following results were observed in the new and manual groups in the sixth week after surgery: average volar tilt: 4.19 ± 3.79 and 4.08 ± 3.88 (p = 0.926), radial angulation: 2.18 ± 1.27 and 2.21 ± 1.35 (p = 0.934), radial shortening: 10.52 ± 0.65 and 10.56 ± 0.68 (p = 0.828), radial inclination: 22.52 ± 2.46 and 22.71 ± 2.01 (p = 0.787), dorsal angulation: -5.89 ± 0.33 and 5.22 ± -1.91 (p = 1.00), ulnar variance: 1.66 ± 0.90 and 1.67 ± 0.81 (p = 0.958), and average pain score: 2.40 ± 0.68 and 2.47 ± 0.73 (p = 0.737). Conclusion: The new reduction procedure with hardware in patients with distal radius fractures showed the same effect as the traditional method based on pressure and traction by the assistant and doctor in terms of radiographic changes and pain score of the fracture site.
RESUMO
INTRODUCTION: Spinal anesthesia is a commonly used anesthetic technique for lower extremity surgery. Despite its widespread use, the acceptable frequency of repeated spinal anesthesia for a patient is unclear. Therefore, herein, we report a patient who frequently received spinal anesthesia. CASE PRESENTATION: A 21-year-old man with severe head and leg injury was admitted to the hospital after a motorcycle accident. On admission, he had a tracheal tube and GCS score of six. After emergency vascular and orthopedic surgeries under general anesthesia, he was transported to the ICU. Within 12 days of admission to the ICU, he was extubated with full awareness. After consultation with a neurosurgeon for spinal anesthesia, the patient received seven spinal anesthesia procedures for his lower extremity injury in a period of 15 days. Spinal anesthesia was performed at the L3 - L4 or L4 - L5 interspace with 24 or 25-gauge Quincke needles in the sitting position (12 - 15 mg of 0.5% hyperbaric bupivacaine) by four anesthesiologists. Despite performing several spinal anesthesia procedures, no neurologic sequelae were observed. Finally, he was discharged in a good overall condition. At a four-month follow-up, the patient was in a stable situation without any neurological complications. CONCLUSIONS: This report emphasizes that spinal anesthesia with hypertonic bupivacaine could be used several times for a patient in some situation.