ABSTRACT
This research investigated the effectiveness of percutaneous Kirschner wire fixation in children with Jacob II and III lateral humeral condyle fractures. 28 children with Jacob II and III lateral humeral condyle fractures were treated with percutaneous Kirschner wire fixation under ultrasound localization, followed by cast immobilization for 4-5 weeks at our institution from January 2018 to April 2022. X-rays were evaluated on the first postoperative day to assess fracture reduction and Kirschner wire fixation. After 2 and 4 weeks, x-rays were taken to assess fracture healing and the presence of discomfort and infection was evaluated. After confirming fracture healing and callus formation, the cast and Kirschner wire were removed. Rehabilitation exercises were conducted following removal to restore elbow function. At the last follow-up, most results were excellent (n = 25) and good (n = 3) according to Flynn's criteria. Moreover, according to the Mayo Elbow Functional Score Scale (MEPS), all 28 children had excellent scores, with no significant difference in MEPS scores between the lesion and healthy sides (t = 1.533, p > 0.05). The present study substantiated that our novel approach is more convenient and effective, brings less trauma and complications and no radiation and deserves clinical promotion.
ABSTRACT
BACKGROUND: Total shoulder arthroplasty and rotator cuff repair surgery result in considerable postoperative pain. Optimal postoperative pain management based on a multidisciplinary approach is necessary to promote early postoperative rehabilitation. The purpose of this study was to compare liposomal bupivacaine (LB) with traditional, non-LB agents after total arthroplasty or rotator cuff repair surgery. METHODS: Two independent authors searched the PubMed Central, Google Scholar, and Cochrane Library websites for suitable articles. We included randomized controlled trials comparing outcomes after the administration of LB and non-LB agents for rotator cuff repair or total shoulder arthroplasty. The outcome measures for our meta-analysis were visual analog scale (VAS) pain scores at 24 and 48 hours after surgery, opioid consumption 24 and 48 hours after surgery, hospital stay duration, and complications within 48 hours after surgery. We used the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) tool to assess the degree of evidence for the outcomes, and we used the Cochrane risk-of-bias assessment tool to assess the risk of bias. RESULTS: The current meta-analysis comprised 11 randomized controlled studies with 846 subjects. Seven studies used local infiltration to administer LB, and 3 used a block. Our pooled analysis results showed no significant difference in VAS pain scores at 24 hours after surgery (standardized mean difference [SMD], -0.27; 95% confidence interval [CI], -0.55 to 0.01; prediction interval, -1.25 to 0.70), VAS pain scores at 48 hours after surgery (SMD, -0.18; 95% CI, -0.46 to 0.09; prediction interval, -1.10 to 0.73), opioid consumption at 24 hours after surgery (SMD, 0.04; 95% CI, -0.27 to 0.34; prediction interval, -1.01 to 1.09), and opioid consumption at 48 hours after surgery (SMD, 0.10; 95% CI, -0.44 to 0.64; prediction interval, -1.76 to 1.96) between the LB and non-LB groups. The LB and non-LB groups had similar hospital stay durations (SMD, -0.38; 95% CI, -1.51 to 0.74; prediction interval, -14.7 to 13.9) and adverse events (risk ratio, 0.89; 95% CI, 0.42 to 1.36) following the shoulder procedures. The level of evidence was low according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) analysis. CONCLUSION: Our meta-analysis provides evidence indicating that LB is similar to non-LB agents in terms of overall pain relief and opioid requirements. The duration of hospital stay and complication rates were also similar in the 2 groups. Future well-designed and adequately powered randomized controlled studies are needed to confirm our results and to be able to recommend LB for various types of shoulder operations.