Post-operative rounds by anaesthesiologists after hip fracture surgery: a pilot study.

BACKGROUND: Efforts to optimize the peri-operative care of hip fracture patients through multidisciplinary intervention have focused on orthopaedic-geriatric liaisons, which have not resulted in significant outcome changes. The early phase of rehabilitation could potentially be optimized through a multidisciplinary effort between anaesthesiologists and orthopaedic surgeons. METHODS: During the first 25 weeks of 2004, 98 consecutive community-residing patients admitted to a hip fracture unit received daily rounds by anaesthesiologists during the first four post-operative days, on weekdays only, focusing on all facets of peri-operative care. Two hours were allotted to rounds in the 14-bed unit. One hundred and twenty-six consecutive patients admitted to the unit in 2003, receiving the same well-defined care programme, were chosen as a control group. Outcome measures were morbidity and the need for visits by external specialists. RESULTS: The intervention group received 291 rounds by anaesthesiologists. Active therapeutic interventions were prescribed in 76% of all patient confrontations. The control group received 128 requested visits from internal medicine specialists, which was reduced to 50 in the intervention group (P = 0.02). There was no significant difference between post-operative morbidity and hospital stay in the control and intervention groups; in-hospital mortality was 12% in the control group and 7% in the intervention group (P = 0.24). The rounds by anaesthesiologists improved nursing care conditions. CONCLUSION: This pilot study, with insufficient power to show significant differences in outcome, supports further evaluation of the concept of intensified orthopaedic-anaesthesiological co-operation after hip fracture surgery. Such a randomized trial should evaluate economic and clinical outcome aspects, providing anaesthesiological rounds 7 days per week.

Occupational therapy and Colles' fractures.

In this randomized trial, we enrolled 30 patients treated for a distal radius Colles' type fracture. The fractures were reduced if necessary and fixed in a below-elbow plaster cast for 5 weeks. One group consisting of 14 patients received instructions for shoulder; elbow and finger exercise and the other group consisting of 16 patients had occupational therapy. At 5 weeks, 3 and 9 months we measured the functional scores. There were no statistically significant differences between the groups at any time. It seems that for non-surgically treated patients with a distal radius fracture only instructions are necessary.

Plaster cast compared with bridging external fixation for distal radius fractures of the Colles' type.

We compared two different treatments for displaced distal radius Colles' type fractures (Older type 3 and 4), at two hospitals. We found bridging external fixation superior to reduction and fixation in a dorsal plaster cast regarding both the end-anatomic results at 3 months and the functional scores at 3 and 9 months (modified Gartland and Werley).

Length of immobilisation after fractures of the distal radius.

Thirty-three patients with undisplaced fractures of the distal radius were included in a clinical controlled trial with the purpose of evaluating whether it was safe to reduce the time of immobilisation in a plaster splint from 5 to 3 weeks. We did not find any difference in radiological healing at 3 months or in the functional scores after 3 and 9 months.

No effect of low power laser in lateral epicondylitis.

Thirty-six patients with lateral epicondylitis of the elbow (19 women, 17 men, median age 48 yrs) were treated either with active laser or placebo, 18 patients in each group. The active laser was a GA-AL-AS 30 mW/830 nm low power laser (LPL). The study design was double blind and randomized. The treatment session consisted of eight treatments, two per week. Patients were irradiated on tender points on the lateral epicondyle and in the forearm extensors. Output power was 3,6 J/point. A follow up was performed by telephone, 10 weeks after the last treatment. No difference between laser and placebo was found on lateral elbow pain (Mann Whitney test, 95% confidence limits). We conclude that low power laser offers no advantage over placebo in the treatment of musculoskeletal pain as lateral epicondylitis. Further studies with low power laser treatment of musculoskeletal pain seem useless.

Hypoxaemia after osteosynthesis of hip fractures.

Hypoxaemia may cause postoperative confusion after operations for hip fractures in elderly patients. Twenty-two consecutive patients, with a median age of 73 years, had fractures fixed with a sliding hip screw within 48 hours of admission. The incidence of hypoxaemia was investigated postoperatively using a pulse oximeter. We have demonstrated that this complication occurs frequently on the first day and severe hypoxaemia can be prevented by supplementary oxygen therapy. Our results support the hypothesis that postoperative confusion can be caused by hypoxaemia.

Isolated ulnar shaft fractures. Comparison of treatment by a functional brace and long-arm cast.

In a prospective study, we randomly allocated 39 patients with isolated fractures of the lower two-thirds of the ulnar shaft to treatment either by a prefabricated functional brace or a long-arm cast. Significantly better wrist function and a higher percentage of satisfied patients were found in the braced group. Thirteen patients returned to employment while still wearing the brace but only one was able to work in a cast.

Mediastinal and subcutaneous cervical emphysema caused by perforating sigmoid cancer. Case report.

A case of mediastinal and subcutaneous cervical emphysema due to perforation of a sigmoid cancer is presented. Sudden deterioration and development of subcutaneous and mediastinal emphysema in a chronically ill patient with equivocal abdominal signs should alert the examiner to the possibility of retroperitoneal gastrointestinal perforation.