Endoscopic carpal tunnel release: experience of surgical outcome in a Chinese population.

OBJECTIVE: To review the outcomes of endoscopic carpal tunnel release in a Hong Kong public hospital and identify any predictive factors. DESIGN: Retrospective study. SETTING: Regional hospital with a hand surgery service, Hong Kong. PATIENTS: Between January 2001 and December 2007, records of 145 patients (160 carpal tunnel syndromes) having endoscopic release were reviewed. Five major symptom domains (pain, numbness, nocturnal awakening, weakness, and clumsiness) before and after the operation were scrutinised. Functional status was assessed by grading key pinch and hand grip, as well as complications. INTERVENTION: Endoscopic carpal tunnel release using the modified Chow's extrabursal technique under intravenous anaesthesia. RESULTS: After the 160 procedures performed, 124 (78%) and 132 (83%) of them revealed improvement in terms of numbness and nocturnal awakening, respectively. Also, there were significant improvements in terms of average functional grading of pinch power and grip power. No serious complications due to the surgery were encountered. CONCLUSIONS: Experience using the Chow's two-portal endoscopic technique for the treatment of carpal tunnel syndrome in the Chinese population was encouraging. It was a safe and effective method for treating carpal tunnel syndrome. We advocate endoscopic surgical intervention for patients with refractory relief of symptoms following conservative management.

Haemodynamic instability secondary to minimally displaced pubic rami fractures: a report of two cases.

We report 2 patients with haemodynamic instability secondary to minimally displaced pubic rami fractures following a fall. Both complained of pain and swelling in the abdomen and groin, and had abdominal distension and bruising in the abdomen, groin, and perineum. All these may be early signs of severe vascular injury and should be treated promptly. Both patients were treated with embolisation of the injured vessels using emergency angiography.

Minimally invasive surgery in orthopaedics. Small is beautiful?

With the blooming of minimally invasive procedures in surgical specialties, many orthopaedic subspecialties have been evolving along such lines. Despite the apparent paradox that many orthopaedic implants are quite bulky to start off with, different methods have been adopted to insert them safely with the least possible trauma. Altering time-honoured incisions and surgical techniques has often been helpful. The industry is also very keen to re-design implants for this purpose and has contributed substantial momentum in this direction. Coupled with the use of operating microscopes, endoscopes, and imaging modalities, operations can be performed with greater precision and lesser trauma. The advent of computer-assisted technology is another step forward. It is through constant attention to minimising tissue trauma and a combination of different methods available, that surgeons can achieve the ultimate goals of minimally invasive surgery.

The effectiveness of capsular decompression for internal fixation of intracapsular hip fractures.

PURPOSE: To compare the results of screw fixation plus capsular decompression versus screw fixation alone for managing intracapsular hip fractures. METHODS: Of 201 patients with intracapsular hip fractures, 99 underwent screw fixation with capsular decompression (capsular decompression group) and 102 underwent screw fixation alone (control group). The incidence and time to development of avascular necrosis of the femoral head, union rate, time to union, and other clinical parameters were compared. RESULTS: In patients with displaced fractures, the incidence of avascular necrosis was significantly higher in the control than capsular decompression group, whereas the time to development of this complication was significantly shorter. CONCLUSION: Capsular decompression did not improve the union rate and time to union in undisplaced intracapsular hip fractures, but in displaced fractures it appeared to reduce the incidence and delay the onset of avascular necrosis.

Comparison between percutaneous transverse fixation and intramedullary K-wires in treating closed fractures of the metacarpal neck of the little finger.

We performed a non-randomized controlled clinical trial of 59 clinical cases to compare percutaneous transverse K-wire fixation and intramedullary K-wires in treating closed fractures of the metacarpal neck of the little finger. Twenty-nine patients were treated by percutaneous transverse K-wire fixation and 30 patients were treated with intramedullary K-wires. They were reviewed at a mean follow-up of 24 months for radiological and functional outcome in terms of union rate, union time, complication rate, pain, movement and grip strength. Radiographs did not show any significant differences in the union rate and union time. There was no statistical difference in complication rate, pain scores, total active motion and grip strength between the two groups. The authors suggest that both methods are comparable, good and safe methods of treating closed, displaced fractures of the metacarpal neck of the little finger, without significant complications.

Clear cell chondrosarcoma: case report and ultrastructural study.

A case of clear cell chondrosarcoma in a Chinese patient is described. The clear cells showed strongly positive S-100 protein immunoreactivity. Ultrastructurally 2 types of chondroid cells were demonstrated. One type appeared more primitive with abundant electron-lucent cytoplasm and sparse organelles. The other type of cell was more differentiated with presence of microvilli and numerous dilated cisternae of endoplasmic reticulum. Previous ultrastructural studies on these lesions were reviewed and compared with the present findings.

Use of an electronic barcode system for patient identification during blood transfusion: 3-year experience in a regional hospital.

OBJECTIVE: To evaluate the use of an electronic barcode system for patient identification during blood transfusion. DESIGN: Retrospective study. SETTING: Regional hospital, Hong Kong. PATIENTS: For all patients requiring blood transfusion between May 1999 and April 2002, with the exception of patients in the psychiatric wards and the accident and emergency department, a portable, hand-held scan-and-print electronic device was used to verify and document patients' identity at two critical points of transfusion: blood sampling for the compatibility test and blood administration. MAIN OUTCOME MEASURES: Scope of use of the electronic device, cost, effectiveness, staff compliance, problems and solution for improvement. RESULTS: In the first 3 years of hospital-wide use of the new device, no incidents of blood transfusion to wrong patients, or wrong labelling of blood samples, occurred with 41,00 blood sampling procedures and administration of 27 000 units of blood. Blood sampling took 6 minutes to complete with the use of the electronic device-similar to that taken by the conventional second-checker system. Among hospital staff, the compliance rate of using the new device approached 90%. Battery problems occurred in 12% of episodes of use of the device. CONCLUSIONS: The electronic barcode system was effective in reducing human error related to bedside transfusion procedures. The future goal is to tailor-make a more efficient device with additional functions.

Casting versus percutaneous pinning for extra-articular fractures of the distal radius in an elderly Chinese population: a prospective randomised controlled trial.

We carried out a prospective randomised controlled clinical trial to compare the functional and radiological outcomes of casting with percutaneous pinning in treating extra-articular distal radial fracture in an elderly Chinese population. Sixty patients were randomly allocated by sealed envelopes to either a 'Cast' group (n = 30) or a 'K-wire' group (n = 30). All patients were available for final follow-up assessment. The radiological outcomes in terms of dorsal angulation, radial inclination and radial length were statistically significantly better in the K-wire group, whereas the Mayo wrist score and quality of life, healing rate, healing time, and complications were similar. The functional outcomes and quality of life were not affected by the treatments. Both treatments had a very low rate of complication and high healing rates.

Palmar fixation of dorsally displaced distal radius fractures using locking plates with Smartlock locking screws.

We performed a prospective cohort study on a consecutive series of 35 unstable, dorsally displaced distal radius fractures, which were treated with palmar locking plates and SmartLock locking screws. There were 17 men and 18 women with a mean age of 44 years who were reviewed at a mean follow-up of 10 months. All the fractures healed at a mean time of 7 weeks. Radiographs did not show any change in alignment from the initial postoperative period until fracture union. The average Mayo wrist score was 90 after fracture union. One patient had an early loss of fracture reduction and one patient developed complex regional pain syndrome. There was no difference in the quality of life before and after surgery. Palmar plate fixation using SmartLock locking screws is effective and safe in stabilising unstable dorsally displaced distal radius fracture and produces good radiological and functional outcomes.