Surgical Treatment of Distal Radius Fractures under the Ultrasound-Guided Brachial Plexus Block Performed by Surgeons.

Background: The upper limb surgery under the ultrasound-guided brachial plexus block is becoming popular due to its safety, effectiveness, and convenience. However, the uneven distribution of anesthesiologists become a social problem. Ultrasound-guided brachial plexus block by surgeons has been widespread especially in hand surgeons. We report the surgical treatment of distal radius fractures under the ultrasound-guided brachial plexus block performed by surgeons in our hospital. Methods: The subjects were 101 patients (41 males and 60 females, average age 61.6 years) who underwent surgery for distal radius fractures under ultrasound-guided brachial plexus block administered by orthopedists at our university or related facilities between January 2014 and June 2016. Brachial plexus block was administered through the supraclavicular approach. The time from initiation of anesthesia to initiation of surgery, mean operative time, the presence or absence of additional anesthesia (local infiltration anesthesia, intravenous anesthesia, and general anesthesia), and complications were evaluated. Results: The mean time from brachial plexus block to initiation of surgery was 35.7 (20-68) minutes, and the mean operative time was 90.5 (35-217) minutes. Surgery was completed with brachial plexus block alone in 62 patients (61.4%), and additional anesthesia was necessary in 39 patients (38.6%). Furthermore, general anesthesia was employed in 6 patients (5.9%). No serious complications occurred. Conclusions: According to our results, the operation could be completed with brachial plexus block alone and additional local infiltration anesthesia or intravenous anesthesia in 94.1% (95 cases). However, 6 cases (5.9%) shifted to general anesthesia. Although it needs training, we consider that hand surgery including distal radius fractures treatment under the ultrasound-guided brachial plexus block is possible. On the other hand, cooperation or a cooperative system with anesthesiologists is necessary for surgeons to administer this anesthesia.

Association between leg bowing and serum alkaline phosphatase level regardless of the presence of a radiographic growth plate abnormality in pediatric patients with genu varum.

When children around 2 years of age show leg bowing and diseases are ruled out based on radiographic findings without conducting blood tests, they are classified as "physiologic" genu varum. Since whether or not physiologic genu varum is associated with bone metabolism is unclear, this study was conducted to clarify the association between genu varum and bone metabolism in children. Thirty-five pediatric patients with genu varm who visited our out-patient clinic were enrolled. While two of the 35 children had nutritional rickets, showing abnormalities on both blood test (ALP, ≥1000 IU/L; iPTH, >65 pg/mL and 25(OH)D, ≤20 ng/mL) and radiographs (such as cupping, fraying or splaying), five of 35 children showed abnormalities on blood tests but not radiographs. While metaphyseal-diaphyseal angle (MDA) correlated with serum 25-hydroxy vitamin D (r = -0.35, p = 0.04) and magnesium (r = -0.36, p = 0.04), MDA and femorotibial angle (FTA) correlated with alkaline phosphatase (r = 0.43, p = 0.01 and r = 0.51, p = 0.006, respectively). A ridge regression analysis adjusted for age and body mass index indicated that ALP was associated with MDA and FTA. A logistic regression analysis adjusted for age and BMI indicated that higher ALP influenced an MDA >11°, which indicates the risk for the progression of genu varum (odds ratio 1.002, 95% confidence interval 1.0003-1.003, p = 0.021). The higher ALP (+100 IU), the higher risk of an MDA >11° (odds ratio 1.22). In conclusion, genu varum is associated with the alkaline phosphatase level regardless of the presence of radiographic abnormalities in the growth plate in children.