International orthopaedics
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One hundred adolescents undergoing posterior spinal fusion for scoliosis were reviewed to assess the adequacy of postoperative patient-controlled analgesia. There were 94 females and 6 males. The mean settings for morphine dosage were a loading dose of 114.5 micrograms.kg-1, a bolus dose of 24.8 micrograms.kg-1, and a lockout interval of 9.9 minutes. ⋯ Nausea and vomiting occurred in 45% and pruritus in 15%. There were 7 cases of respiratory depression who all recovered promptly and completely. This method is associated with high morphine requirements in adolescents, but can be used safely.
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Following tension band wiring of fractures of the patella, proximal K-wire migration is a common complication. To prevent this we have devised the 'self locking tension band' technique. ⋯ We have treated 15 fractures using this technique. At a mean follow up of 30 months, no postoperative complications were found.
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Case Reports
Fracture of the shaft of the humerus with a fracture-dislocation of the same shoulder. A case report.
We report the case of a man aged 19 who sustained an anterior dislocation of the shoulder with a fracture of the greater tuberosity, and a fracture of the shaft of the same humerus. Open reduction and internal fixation of the shaft fracture was carried out followed by closed manipulation of the dislocation. He recovered full function of the shoulder and elbow.
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Twelve children with lumbar discitis were reviewed. The average age at diagnosis was 2.5 years. Seven were girls, and the follow-up varied between 2 and 10 years (average 5 years). ⋯ Magnetic resonance imaging helped to diagnose the condition in three. Treatment consisted of bed rest and immobilisation of the spine; intravenous antibiotics were given to nine children. The natural course of the disease was benign in all our twelve cases.
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A retrospective review of complications with the gamma nail has been carried out in 152 patients with stable and unstable pertrochanteric fractures. Operative complications occurred in 10 patients. ⋯ At follow up, pseudarthrosis was present in 2 cases and fractures of the femoral shaft in 4. The incidence of complications could be reduced by using of shorter nails, less valgus angulation and by not introducing distal screws unless essential.