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BACKGROUND: The aim of this study was to assess residual humpback deformity after arthroscopic treatment of scaphoid non-union. MATERIAL AND METHOD: We reviewed the medical records of 47 patients with scaphoid non-union who underwent arthroscopic treatment between 2012 and 2018. Patients who did not receive an intraoperative bone graft were excluded (10 patients), as were those who did not achieve bone union (three patients). The radiographic assessment consisted of pre- and postoperative radiographs and CT-scans. RESULTS: The radiolunate angle, scapholunate angle and Youm index were measured. At the final follow-up, the scapholunate angle was 54±8Ì (36-80Ì) and the radiolunate angle was 11±7Ì (2-45Ì). The scapholunate angle was significantly different between the preoperative measurement and the last follow-up; however, the radiolunate angle and Youm index did not change significantly. CONCLUSION: Our study found that arthroscopic treatment of scaphoid non-union with a cancellous bone graft taken from the distal radius results corrects the humpback deformity. LEVEL OF EVIDENCE: IV.
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INTRODUCTION: The primary aim of this study was to evaluate how the Game Ready© cryotherapy system impacts postoperative analgesia following lumbar fusion. The secondary aim was to study the effect of cryotherapy on blood loss, transfusion rate and recovery after surgery. MATERIALS AND METHODS: This was a retrospective study of 60 patients divided into two consecutive sets. The first set of 30 patients underwent the current anesthesia protocol at our facility (control group) while the second set of 30 underwent the same protocol but the patient wore the Game Ready© cryotherapy belt immediately postoperative (GR group). RESULTS: VAS for pain at H6 did not differ between groups [5.2±1.7 vs. 5.2±1.8 (p=0.94)]; however, there was a significant decrease in pain at H24 and H48 in the GR group relative to the control group (p=0.04; p=0.01; p=0.01). Consumption of morphine over the first 24 and 48hours was 50% less in the GR group than in the control group (p=0.01 and p<0.0001). Discharge occurred significantly earlier in the GR group (3.9±1.0 days) than the control group (5.1±0.9 days) (p<0.001). The estimated blood loss was greater in the control group than the GR group (574.7ml±339.2 vs. 305.9ml±229.6; p=0.0003). CONCLUSION: Use of a cryotherapy device in the context of spine surgery is effective at controlling postoperative pain. It also decreases the consumption of analgesics, limits blood loss, reduces the need for transfusions, and contributes to enhanced recovery after surgery. LEVEL OF EVIDENCE: IV.
Asunto(s)
Dolor Postoperatorio , Fusión Vertebral , Analgésicos Opioides/uso terapéutico , Humanos , Vértebras Lumbares/cirugía , Región Lumbosacra , Morfina , Dolor Postoperatorio/prevención & control , Estudios Retrospectivos , Fusión Vertebral/métodos , Resultado del TratamientoRESUMEN
INTRODUCTION: Intrathecal morphine (ITM) is a well-known and extensively used method for analgesia in various surgical fields; however, its relevance in spine surgery is debated given the conflicting results in the literature. The aim of this study was to investigate the opioid-sparing effect of ITM after lumbar fusion. METHODS: This retrospective study involves two consecutive series of patients undergoing posterior lumbar fusion. The first cohort (control group, n=30) received the standard analgesia protocol while the second cohort (ITM Group, n=30) had the standard protocol supplemented with ITM (100µg of morphine hydrochloride). Morphine consumption, pain assessment (VAS), specific complications and postoperative recovery data were collected. RESULTS: Consumption of morphine at 24hours and 48hours postoperatively was lower in the ITM group than the control group (p<0.001 and p=0.004). The pattern was similar for pain on VAS at H6, H24 and H36 (p=0.001; p=0.003 and p=0.01). The patients in the ITM group were able to get out of bed faster than the controls (1.13 days vs 1.83 days, p=0.002) and the discharge was earlier in the ITM group (5.1 days vs. 6.2 days, p=0.002). There was no difference in morphine-specific complications between the two groups. CONCLUSION: Adding ITM to the analgesia protocol for lumbar fusion provides better management of postoperative pain, without increasing early complications, and it accelerates the recovery process after surgery. LEVEL OF EVIDENCE: IV.