Lower tourniquet pressure does not affect pain nor knee-extension strength in patients after total knee arthroplasty: a randomized controlled trial.

PURPOSE: The use of a tourniquet in total knee replacement has advantages and drawbacks. Some studies suggest that using ischaemia at low pressures could reduce its negative effects. Our objective is to verify whether the use of ischaemia at low pressures (100 mmHg above the systolic blood pressure) produces greater pain and loss of strength than surgery without a tourniquet. METHODS: By the means of a prospective randomized clinical trial, patients were assigned to the control group (no tourniquet, NT) or the experimental group (tourniquet, T). The main variables measured were pain (VAS) and isometric muscle strength (preoperatively, 10 days and 3 months after surgery). Secondary variables were haemoglobin at 24 h, transfusion index, need for rescue drugs and days of admission. RESULTS: A total of 71 patients (73 prosthesis) were studied. Both groups were homogeneous in terms of age, body mass index, sex ratio, preoperative strength and level of anesthetic risk. We did not find significative differences in any of the main variables (pain and strength) nor in the secondary ones. We could only find differences in the days of admission (2.77 vs. 3.05; p = 0.031). CONCLUSIONS: Use of a tourniquet at low pressures (100 mmHg above systolic blood pressure) did not result in an increase in postoperative pain or a decrease in quadriceps extension force within the first 3 months after surgery. LEVEL OF EVIDENCE: Level 1-Randomized controlled trial.

Luxación esternoclavicular posterior / Posterior sternoclavicular dislocation / Luxação posterior esternoclavicular

La luxación esternoclavicular posterior es una patología extremadamente infrecuente, que se presenta, sobre todo, en varones jóvenes como consecuencia de un traumatismo de alta energía. Hasta en un 25% de los casos pueden aparecer complicaciones potencialmente letales por compresión de estructuras mediastínicas, que requieren de la reducción urgente de la luxación. El diagnóstico radiográfico puede ser difícil, siendo de gran utilidad la tomografía computerizada para determinar el tipo y grado de desplazamiento, así como la relación anatómica con las estructuras mediastínicas. Se presenta el caso de una paciente de 14 años de edad que presentó una luxación esternoclavicular posterior traumática aguda tras una caída practicando karate

Posterior sternoclavicular joint dislocation is an extremely rare condition, usually seen in males after high energy concussion. Potentially lethal complications may appear in 25% of cases, due to compression of mediastinic structures. Radiological diagnose may be difficult, why computed tomography is usually used to determine type and grade of displacement and relation with mediastinic structures. We present a case of a 14 year-old woman who presented a posterior sternoclavicular dislocation due to a fall while playing karate

A luxação posterior esternoclavicular é a condição extremamente rara, que ocorre principalmente em homens jovens, como resultado de trauma de alta impacto. Em até 25% dos casos, podem acontecer complicações potencialmente fatais por compressão de estruturas do mediastino, que exigem a redução urgente da luxação. O diagnóstico radiográfico pode ser difícil, sendo a tomografia computadorizada considerada útil para determinar o tipo e grau de deslocamento e a relação anatômica com as estruturas do mediastino. Aqui se apresenta o caso de um jovem de 14 anos que apresentou uma luxação esternoclavicular posterior traumática aguda após uma queda durante a prática de karatê