Orthopedics
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The upper extremities of two elderly cadavers were amputated at the fore-quarter level and underwent placement of the Biomet uniflex humeral nail in the left extremities and the Richards Russell-Taylor humeral nail in the right extremities. Distal locking screws were placed lateral to medial in the Biomet nails and in the anterior to posterior plane in the Richards nails. Dissection was performed about the distal humerus to identify the neurovascular structures at risk from screw placement. ⋯ The musculocutaneous nerve was at direct risk with placement of a distal screw from anterior to posterior. Sections of the distal humerus demonstrated the medullary canal to begin narrowing at 3 cm and fill with dense bone 1.5 cm superior to the proximal edge of the olecranon fossa. This may interfere with distal placement of the humeral nail, altering the position of the distal fixation holes, and also may contribute to distraction at the fracture site.
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Carpal tunnel release is usually performed in a hospital setting with regional anesthesia. The cost for use of the hospital operating room, anesthesia, and surgeon's fee is quite excessive. ⋯ There have been no complications, and the 20 patients interviewed and examined for this article preferred the office procedure over the hospital procedure. Carpal tunnel release can be performed safely in the office, and is less expensive than when done in a hospital setting.
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A method of regional anesthesia use in forefoot and midfoot surgery is described. Careful identification of the peripheral sensory nerves allows for effective anesthesia using bupivacaine and lidocaine in addition to sedation for comfort. ⋯ Complications were found to be minimal and patient satisfaction was high. This method provides a safe and effective anesthesia alternative for foot and ankle surgery.