Patient satisfaction following carpal-tunnel decompression: a comparison of patients with and without osteoarthritis of the wrist.

The aim of this study was to assess whether surgical decompression for carpal-tunnel syndrome (CTS) in the presence of primary or secondary osteoarthritis of the wrist is associated with poorer patient satisfaction. We did a retrospective matched cohort study. Twenty-four patients who underwent surgical decompression for CTS secondary to osteoarthritis were identified by reviewing the notes and the radiographs. A control group consisted of 24 patients without osteoarthritis of the wrist who underwent carpal-tunnel decompression. The control group was matched for age, sex, side, and neuro-physiological severity of the nerve compression. In the group with osteoarthritis of the wrist, 17 (71%) patients reported their symptom relief as satisfactory, and 7 (29%) reported the results as unsatisfactory. In the control group, 23 (96%) patients reported their symptom relief as satisfactory, and 1 (4%) reported the results as unsatisfactory (P=0.0325). In conclusion, patient satisfaction following surgical decompression in patients with secondary CTS due to osteoarthritis was significantly lower compared to patients without osteoarthritis of the wrist.

Knee skin temperature following uncomplicated total knee replacement.

This prospective study aimed to establish the pattern of knee skin temperature following uncomplicated primary total knee replacement. Thirty-two patients were included. The skin temperature of operated and contralateral knees was measured preoperatively and daily during the first 6 weeks postoperatively. Measurements were also taken at 3, 6, 12 and 24 months following surgery. The difference in temperature between the two knees had a mean value of (+)2.9 degrees C at 7 days. This mean value decreased to (+)1.6 degrees C at 6 weeks, (+)1.3 degrees C at 3 months, (+)0.9 degrees C at 6 months (+)0.3 degrees C at 12 months and (+)0.0 degrees C at 24 months. Following uncomplicated total knee replacement, the operated knee skin temperature increases compared to the contralateral knee. The difference decreases gradually but remains statistically significant up to at least 6 months following surgery. In the absence of other features of infection, local knee warmth should not cause concern.

Necrotising fasciitis of the shoulder following muscular strain.

Necrotising fasciitis is a rare, life-threatening, soft-tissue infection characterised by rapidly spreading inflammation and subsequent necrosis of the muscle, fascia and surrounding tissues. We report a case of necrotising fasciitis originating from the shoulder in a 59-year-old female patient. Necrotising fasciitis of the shoulder is very rare and has a poor prognosis because of its potential to spread to the chest wall. It can occur in otherwise healthy people without any predisposing conditions and could present as muscle strain. Disproportionate pain is the hallmark of this condition. Ultrasound examination and aspiration of fluid from the involved area is a fast and efficient method of reaching the diagnosis.

Fixation failure of the clavicular hook plate: a report of three cases.

Open reduction and internal fixation for unstable fractures of the lateral end of the clavicle (Neer type II) is not complication-free. Most clavicle fractures can be successfully treated by conservative methods. Neer type II fractures have a reportedly high rate of nonunion, therefore internal fixation is recommended. However, the need for surgical treatment remains controversial as nonunion seldom produces a poor functional outcome. We report 3 cases of fixation failure following treatment with a clavicular hook plate. None of the patients required re-fixation surgery and all achieved bony union with a good functional result.

Dynamic compression plate fixation for post-operative fractures around the tip of a hip prosthesis.

Post-operative fractures around the tip of the femoral component of a hip prosthesis are inherently unstable and have been reported to be associated with high nonunion rate if treated conservatively. A group of 27 of these fractures were treated with dynamic compression plates between 1994 and 2000. The fractures followed primary total hip arthroplasty in 10 cases, revision surgery in five cases and hemiarthroplasty in 12 cases. According to the Vancouver classification, there were 18 type B1, six type B2 and three type B3 fractures. The average age was 82 years. The average follow up was 35.7 months (range 12-72 months). Complications included one nonunion (B3) and three fixation failures (one B2 and two B3). Also, two cases became infected, one of these was managed conservatively, the other needed removal of plate and prosthesis. Twenty patients regained their pre-injury mobility. Dynamic compression plate fixation is sufficient for type B1 and some selected cases of type B2 fractures that occur around the tip of a hip prosthesis.

Average versus maximum grip strength: which is more consistent?

The average of three consecutive measurements is the most frequently used method for grip strength assessment. The purpose of this study was to compare the consistency of the maximum value with that of the average value of three consecutive measurements of grip strength. One hundred healthy volunteers participated in this study. Three measurements of grip strength were taken on two occasions separated by 2 weeks. For each hand, two average values and two maximum values were obtained. Ninety-five per cent limits of agreement for the average method were - 8.3 (-23%) to +7.2 (+20%)kg and for the maximum method were - 8.8 (-23%) to + 8 (+21%)kg. Both methods of grip strength assessment were found to be highly consistent with no statistically significant difference.