Comparisons of analgesic effects of different doses of morphine and morphine plus methylprednisolone after knee surgery.

BACKGROUND: In this double-blind randomized study, the analgesic effects of morphine alone and with methylprednisolone were examined in 72 patients undergoing arthroscopic knee surgery. METHODS: At the end of arthroscopy, patients were allocated randomly to one of four groups to receive intra-articular administrations of saline, morphine 1 mg, morphine 5 mg or morphine 1 mg with methylprednisolone 40 mg. Preoperative and postoperative pain levels at rest and during movement (active flexion of the knee) were measured by a visual analogue scale (VAS). Postoperative analgesic requirements to alleviate pain were evaluated. RESULTS: Pain scores were significantly lower for the patients who received 5 mg morphine and 1 mg morphine with 40 mg methylprednisolone than for those who received saline or 1 mg morphine. This was accompanied by a decrease in the postoperative consumption of analgesics and prolongation of the duration of pain relief. CONCLUSIONS: This study confirms that the analgesic effect of morphine given intra-articularly is dose dependent and that combination of methylprednisolone with morphine has an additive effect on analgesia.

Effects of Salter innominate osteotomy on the sacroiliac joint in patients with developmental hip dysplasia.

The pressure effects of Salter innominate osteotomy (SIO), a surgical treatment for developmental hip dysplasia (DHD), on the sacroiliac joint were investigated in a retrospective study. Pre- and post-operative direct anteroposterior pelvic radiographs of 60 cases with unilateral DHD treated by SIO were examined. The mean age at surgery was 27.7 months (range 18-48 months). The distance from the posterior inferior iliac spine to the midline (from the middle of the first sacral vertebra to the symphysis pubis) was measured. No difference was found between pre- and post-operative distances on the normal, non-operated side. On the operated side, no change was observed in 10 cases (16.7%), but the distance increased by 2 mm or 3 mm in 50 cases (83.3%) post-operatively. This increase was statistically significant, but not related to age at surgery. These findings indicate that SIO creates pressure on the inferior part of the sacroiliac joint, resulting in some displacement. Such irreversible changes may eventually lead to joint degeneration and pain.

Primary hydatidosis of the gracilis muscle in a girl.

Primary muscle hydatidosis is very rare. Rupture and spreading of the cyst contents by improper handling may later cause secondary cyst or allergic reactions. Preoperative recognition of a hydatid cyst is therefore critical. It often presents as a soft-tissue mass, however, and pre-operative recognition of this rare entity is clearly difficult. Here, a case of primary hydatidosis affecting the gracilis muscle is presented, and the magnetic resonance imaging, clinical and pathological findings are described.

Congenital bilateral short femur complicated by stress fracture. A case report.

Congenital malformation of the femur is an uncommon but complex problem. Short femur with proximal deficiency (Kalamchi type III) is part of this congenital anomaly. If the precautions associated with progressive coxa vara and bowing in the femoral shaft are not taken, stress fractures may occur in the femoral neck and the femoral shaft. We report on a 38-year-old female with type III-A congenital malformation of both femurs who presented the complications mentioned and had not been treated before. This case is instructive because it illustrates the complications developed in patients who have not been treated.

Sport injuries in right- and left-handers.

The incidences of sport injuries in right- and left-handed subject was investigated. Of 40 left-handed athletes, 33 (83.0%) had sport injuries; of 279 right-handed athletes, 189 (68.0%) had sport injuries. These findings suggest left-handers may be more susceptible to accident-related injuries.