[Scaphoid fractures: a comparison of two surgical methods for internal fixation using either Herbert screws or multiple pins]

Scaphoid fractures are the most common fractures of the wrist. This study compared the outcomes of two surgical internal fixation techniques, using either Herbert screws [HS group] or multiple pins [MP group], in the treatment of scaphoid fractures. This cross-sectional study was performed on 41 patients [23 in HS and 18 in MP groups] with unilateral scaphoid fractures from September 2009 to September 2011. All patients were followed-up two weeks post-surgery, every month for six months, and then every year after one year. Degree of fracture healing, measured level of pain using Visual Analog Scale [VAS], range of motion, hand grip strength of affected limb vs. healthy limb, Quick DASH score [QD] and also Mayo Modified Wrist Score [MMWS] were recorded. In December 2012, all patients presented to the Orthopedic Clinic for their final follow-up visit where all data was recorded once more. Mean patient follow-up time was 24.34 +/- 8.70 months [range: 11-34]. Mean scaphoid fracture healing times for the HS and MP group were 14.61 +/- 3.88 and 14.39 +/- 4.27 weeks, respectively. No statistically significant difference was found between both groups after comparing mean levels of pain using VAS, ROM of wrist during flexion and extension, hand grip strength expressed as percentage of normal, QD, and MMWS. The level of patients' content using VAS was 9.5 for HS and 9.0 for MP groups. The use of multiple pins for the internal fixation of scaphoid fractures proves to be a viable treatment option compared to Herbert Screws, due to decreased cost and increased availability

gabapentin effective on pain management after ar-throscopic anterior cruciate ligament reconstruction? a triple blinded randomized controlled trial

Acute pain is common after arthroscopic surgeries and it is one of the most important causes of patient dissatisfaction, admission time and increased morbidity, Gabapentin with anti-hyperalgesic effects can play a critical role in pre-emptive analgesia methods. The aim of this study was to assess the efficacy of gabapentin in pain management after surgery and the rate of drug consumption in patients who are candidate for anterior cruciate ligament [ACL] reconstruction arthroscopic surgery. In this randomized, triple blind clinical trial, 114 patients who were candidate for arthroscopic ACL reconstruction were divided into two groups of gabapentin [G] and placebo [p], with 57 patients in each group. The intervention group received gabapentin 600 mg and a placebo was administered in control group. Patients received on-demand pethedine for pain management. The primary outcome was pain intensity according to the visual analogue scale [VAS] and the secondary outcome was the amount of opioid consumption and incidence of side effects [including: dizziness, sedation, nausea and vomiting] at 6 and 24 h visits. The mean pain intensity in G group at both the 6 and 24 hour visits was significantly lower than the control group [Both p<0.0001]. Also, patients in the gabapentin group consumed less opioid at both visits in comparison to the placebo group [p<0.001, p=0.032]. The incidence rate of sedation, dizziness, nausea and vomiting was similar in both groups. In arthroscopic ACL reconstruction, administering a preoperative single dose of 600mg gabapentin may decrease both pain intensity and opioid consumption

[Functional outcomes of radial nerve palsy associated with humeral fractures using microscopic nerve repair procedures]

Radial Nerve Palsy [RNP] is the most common nerve lesion complicating humeral shaft fractures in 2%-17% of cases. Exploration timing [early or delayed] and various nerve repair procedures are still matter of dispute. The objective of this study is to determine the functional treatment outcome of microsurgeric repair of RNP associated with humeral fractures. In this retrospective study of 20 patients [15 males and 5 females with a mean age of 35 +/- 12.5] with humeral fractures, 15 cases had primary RNP and t he other 5 cases experienced nerve palsy after their orthopedic manipulations [secondary or iatrogenic RNP]. Of the first 15 patients, 7 cases had open humeral fractures which were treated using ORIF and early exploration procedures and 8 cases with closed humeral fractures treated conservatively with closed reductioncasting and delayed exploration after 3months because of no recovery. Iatrogenic RNP were observed for 3 months and explored after no sign of recovery. Nerve repair procedures were performed based on nerve injury and patients were followed up for a mean of 24.4 +/- 2.5 months [19-20 months]. Exploration findings, kind of nerve repair and functional recovery rate [based on Alnot criteria] were recorded and analyzed using SPSS-19 software. Of the 7 cases who suffered from total radial nerve transection [repaired by interfasicular grafting] 3 cases had good outcome, 2 cases had fair outcome and 2 cases were failed. Exploration of 3 cases revealed partial nerve tearing [repaired by neurorrhaph y] with good results. Eight cases with perineural fibrosis and 2 cases of nerve entrapment in callus were treated by interfasicular neurolysis and the results were good. Overall recovery rate of these three procedures was 90%. In patients with RNP associated with humeral fractures, choosing proper microsurgeric nerve repair and determining proper exploration timing [early or delayed] could result in desirable functional outcomes