M. Tryfonidis | University of Central Lancashire (Cyprus) (original) (raw)
Papers by M. Tryfonidis
Adolescents, Jan 24, 2024
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Foot and Ankle Surgery, 2010
There is no universally accepted method of classification of tibial plateau fractures, with more ... more There is no universally accepted method of classification of tibial plateau fractures, with more than six classification schemes having been described. Of these, the Schatzker and AO/OTA classifications are the most commonly used methods for classifying such fractures. 1,2 There is little information regarding inter- and intra-observer variation when classifying tibial plateau fractures using the Schatzker and AO/OTA classification systems and hence this study was performed.
Erratum: Inter- and intra-observer variation of the Schatzker and AO/OTA classifications of tibial plateau fractures and a proposal of a new classification system (Annals of the Royal College of Surgeons of England (2007) vol. 89 (400-404) 10.1308/003588407X187667)
Annals of The Royal College of Surgeons of England, 2007
Upper limb spasticity surgery in adults: What we learned in 5 years of practicing it
Journal of Musculoskeletal Surgery and Research, 2019
We have been practicing surgical management of adult upper limb spasticity for the past 5 years. ... more We have been practicing surgical management of adult upper limb spasticity for the past 5 years. So far, we have evaluated 20 patients, and we have operated on nine patients with spasticity of the upper limb in Cyprus and the United Kingdom. We aim to present the setup and running of a new service, which is devoted to Surgery for Spasticity of the Upper Limb. We present our structure, organisational processes and service provision as well as our results in the nine cases that had surgical treatment as a part of their management (as well as our preferred techniques). We discuss our outcomes as well as our learning points from these cases. We also believe that selective neurectomy procedures can be very useful in the surgical management of upper limb spasticity. Tendon transfers to augment finger extension have a limited role and provide no significant benefits in adult spasticity cases. In addition, we found that the extensor carpi ulnaris transfer to extensor carpi radialis brevis has in our experience, reliable results regarding concentric wrist extension as well as easier rehabilitation. Furthermore, in severe cases, where no functional improvement is expected, joint fusions have a more predictable outcome. Spasticity reduction surgery does gain ground with the increase in survival of stroke patients as well as traumatic brain injury patients. Therefore, up to date methods for assessing, operating and evaluating postoperatively this category of patients need to be vigorously checked.
Journal of Genetics, 2016
Haploinsufficiency of the short stature homeobox contaning SHOX gene has been shown to result in ... more Haploinsufficiency of the short stature homeobox contaning SHOX gene has been shown to result in a spectrum of phenotypes ranging from Leri-Weill dyschondrosteosis (LWD) at the more severe end to SHOX-related short stature at the milder end of the spectrum. Most alterations are whole gene deletions, point mutations within the coding region, or microdeletions in its flanking sequences. Here, we present the clinical and molecular data as well as the potential molecular mechanism underlying a novel microdeletion, causing a variable SHOX-related haploinsufficiency disorder in a three-generation family. The phenotype resembles that of LWD in females, in males, however, the phenotypic expression is milder. The 15523-bp SHOX intragenic deletion, encompassing exons 3-6, was initially detected by array-CGH, followed by MLPA analysis. Sequencing of the breakpoints indicated an Alu recombination-mediated deletion (ARMD) as the potential causative mechanism.
Injury Extra, 2008
features in the bone marrow indicating depletion of the stem cell pool after major trauma, which ... more features in the bone marrow indicating depletion of the stem cell pool after major trauma, which we hypothesise will be associated with changes in related colony stimulating factors (GM-CSF and G-CSF) and the functional efficacy of circulating neutrophils and monocytes. Methods: Study population groups: (1) Major blunt trauma patients (ISS > 18) with pelvic, acetabular or femoral shaft fractures (N = 9, mean ISS 29 (27-41)). (2) Isolated pelvic, acetabular or femoral shaft fractures. (3) Surgical controls undergoing pelvic or femoral shaft surgery without an acute injury. Blood samples were obtained at admission, the time of fracture surgery (along with bone marrow) and at 2 and 5 days post-op. Results: The percentage CD34+ cells (immature progenitors) were significantly reduced in the bone marrow of major trauma patients as previously described, and significantly more immature CD35− cells were found in the circulation. These proved unable to transmigrate in response to IL-8 in vitro. Circulating levels of GM-CSF and G-CSF were suppressed after major trauma. Extensive transfusion was required with a median of 8 (range 2-16) units required prior to fracture fixation. Neutrophil respiratory burst activity remained elevated throughout this period, while monocyte HLA-DR expression was reduced. Discussion: The dysfunction of circulating neutrophils and monocytes is in keeping with previous data. Suppressed GM-CSF and GCSF levels were unexpected and may be related to the failure of the bone marrow to restore its progenitor pool and thus produce dysfunctional leukocytes. Therapeutic manipulation of this may prove possible.
Foot & Ankle International, 2009
Background: The poor vascularity of tendons is a major factor in their limited healing capacity. ... more Background: The poor vascularity of tendons is a major factor in their limited healing capacity. The aim of this study was to assess the effect of Platelet Rich Plasma (PRP) on angiogenesis during tendon healing. Materials and Methods: Forty-eight skeletally mature New Zealand White rabbits were used. The Achilles tendon was transected transversely and 0.5 ml of PRP was injected into the tendon mass on each side of the incision on both limbs. The injection in the control group consisted of saline. Six animals from each group (12 tendons each) were sacrificed after 1, 2, 3, and 4 weeks following treatment. Three sections from each Achilles were stained with hematoxylinosin for microscopic examination. Further three sections were immunostained with a monoclonal antibody against CD31 (Daco Co), followed by image analysis to count new vessel numbers and statistical analysis was performed. Results: There was significantly more angiogenesis in the PRP group compared to the control group d...
Optimisation of Screw Thread Length and the Effect on Union in Subtalar Fusion
Introduction: An ideal screw for subtalar fusion would be designed such that screw thread length ... more Introduction: An ideal screw for subtalar fusion would be designed such that screw thread length in the distal bone would be maximised but without distal perforation, whilst having no threads across the fusion site that would inhibit compression. Method: Radiographs and clinical assessment of 100 patients who had undergone subtalar fusion were analysed and correlated with the presence or absence of non-union. In addition, using the characteristics of the inserted screw as a scaleable marker, it was calculated what would have been the optimum length of screw thread in order to maximise screw thread length in the target bone whilst preventing the screw threads being across the fusion site. Results: There is no correlation between the presence of screw threads across the fusion site and non-union. Currently available screws have thread lengths that are either too long (breaching the fusion site) or too short for ideal fixation and we propose a different thread length to those currently...
Corrigendum to: When should old therapies be abandoned? A modern look at old studies on topical ampicillin [Journal of Infection 47 (2003): 203–209]
Journal of Infection, 2008
Strategies in trauma and limb reconstruction (Online), Jan 13, 2015
We report our experience in treating victims of the recent earthquake disaster in Pakistan. Our e... more We report our experience in treating victims of the recent earthquake disaster in Pakistan. Our experience was based on two humanitarian missions to Islamabad: one in October 2005, 10 days after the earthquake, and the second in January 2006. The mission consisted of a team of orthopaedic surgeons and a second team of plastic surgeons. The orthopaedic team bought all the equipment for application of Ilizarov external fixators. We treated patients who had already received basic treatment in the region of the disaster and subsequently had been evacuated to Islamabad. During the first visit, we treated 12 injured limbs in 11 patients. Four of these patients were children. All cases consisted of complex multifragmentary fractures associated with severe crush injuries. All fractures involved the tibia, which were treated with Ilizarov external fixators. Nine fractures were type 3b open injuries. Eight were infected requiring debridement of infected bone and acute shortening. During a sec...
Introduction: We present the long term results in 204 cases of Hallux Valgus deformity correction... more Introduction: We present the long term results in 204 cases of Hallux Valgus deformity correction using a modified Mitchell’s osteotomy. Methods: 168 patients (204 feet) that had Mitchell’s osteotomies between 1986 and 2001 were recalled for clinical and radiological evaluation. The patients had hallux valgus angles of up to 50o and intermetatarsal angles of up to 20o. They all had a modified procedure using two crossed Kirschner wires to fix the capital fragment into plantar displacement and angulation. Lateral soft tissue release was performed when deemed necessary during the procedure. Mild to moderate arthritis of the 1st metatarsophalangeal joint was not a contraindication. The AOFAS scores as well as any complications were recorded and the Xrays were used to measure hallux valgus and intermetatarsal angles. Mann-Whitney U test was used to analyze data. Results: The mean follow up was 12.9 years. The mean AOFAS score improved from a preoperative of 49.6 to a postoperative of 87...
The Nerve Supply of the Supinator Muscle Revisited: An Anatomical Study That Adds to the Understanding of Radial Tunnel Syndrome
A significant number of patients return with persistent symptoms following surgical release of th... more A significant number of patients return with persistent symptoms following surgical release of the posterior interosseous nerve for radial tunnel syndrome. The aim of this study was to attempt to explain this fact in anatomical terms by defining the anatomy of the posterior interosseous nerve and its branches in relation to the supinator muscle and arcade of Frohse. Using standard dissection tools 20 preserved cadaveric upper limbs were dissected. The radial nerve and all its branches within the radial tunnel were exposed and a digital calliper was used to measure distances. The bifurcation of the radial nerve to posterior interosseous nerve and superficial sensory branch occurred at a median distance of 4.35mm proximal to the elbow joint-line. The bifurcation was proximal to the joint-line in 11 cases, at the level of the joint-line in one case and distal in eight cases. There was a range of 0–5 branches to the supinator originating proximal to the entry point of the posterior inte...
Incidence of Cervical Rib in the White British Population and Direct Comparison with the Incidence in the Asian Population: A Radiological Study
A number of studies have looked at the incidence of cervical rib in various ethnic groups, but ha... more A number of studies have looked at the incidence of cervical rib in various ethnic groups, but have a number of limitations. This is the first large scale study looking at the incidence in White British with direct comparison to the Asian population. A total of 1545 consecutive cervical spine radiographs performed for any reason were collected and reviewed. 5.9% of White British and 24.9% of Asian patients had evidence of cervical rib. This was statistically significant (p be considered in the assessment of patients with symptoms of thoracic outlet syndrome, taken into account during review of cervical spine radiographs and included in anatomy textbooks in the future.
Picture Quiz: Falling on an outstretched arm
BMJ
A 6 year old boy attended the emergency department with an isolated injury to his left elbow afte... more A 6 year old boy attended the emergency department with an isolated injury to his left elbow after falling on his outstretched left arm. On examination, the left elbow joint was swollen and clinically deformed with diffuse tenderness. The skin was intact and there was no neurovascular deficit in the left upper limb. We x rayed the elbow (figure). X ray of the boy's elbow 1. What does the x ray film show? 2. What should the assessment of such an incident include? 3. What is the classification of supracondylar fractures of the humerus? 4. What are the potential complications of supracondylar fractures? 5. How should this fracture be managed? 1. The x ray film shows a displaced supracondylar fracture of the left humerus with the distal fragment of the humerus displaced posteriorly. 2. Assessment should include a quick general evaluation of the patient to ensure that the airways are patent, breathing is …
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2006
The aim of this study was to compare intra-articular anesthesia alone versus general anesthesia w... more The aim of this study was to compare intra-articular anesthesia alone versus general anesthesia with regard to ease of the procedure, level of postoperative pain, and patient satisfaction when partial meniscectomy is anticipated. Methods: We prospectively randomized to general anesthesia or to intra-articular anesthesia 107 patients who were about to undergo knee arthroscopy, in whom partial meniscal resection was anticipated on the basis of clinical or radiologic grounds. Technical difficulty of the procedure, level of postoperative pain and nausea, and overall patient satisfaction were assessed. Results: The ease of obtaining arthroscopic views, the adequacy of these views, and the ease of performing partial meniscal resection or another procedure were similar in both groups according to scores assigned by the operating surgeon. Pain at 6 hours postoperatively was significantly less in the intra-articular anesthesia group but was similar in the 2 groups at 24 and 48 hours. Patients who were given intra-articular anesthesia reported higher satisfaction rates in understanding the underlying disease of the knee. Conclusions: We propose that intra-articular anesthesia alone can be effectively used in knee arthroscopies in which partial meniscal resection is anticipated. Level of Evidence: Level I, high-quality randomized controlled therapeutic trial.
The first description in the literature, of a complication during the extraction of a retrograde expandable intra-medullary nail in three patients
Trauma Case Reports, 2016
Injury-international Journal of The Care of The Injured, 2005
Has the assessment of isolated ankle injuries altered since 1993?
Emergency medicine journal : EMJ, 2005
Performance of emergency departments in England and Wales has declined in recent years. Data from... more Performance of emergency departments in England and Wales has declined in recent years. Data from the authors' department has shown that junior doctors now see fewer patients and spend longer over their assessment than was the case previously. This study aimed to determine how the assessment of patients with isolated ankle injuries changed over an 11 year period. A retrospective case note review was conducted. Data regarding the duration of assessment, clinical information recorded, investigations, and treatments were retrieved. During the period studied 13 555 patients presented with isolated ankle injuries; case notes of 550 of these patients were reviewed in the present study. Linear regression demonstrated that the median length of time from arrival in the department until seen by a clinician increased (b = 3.0 min/year, 95% CI 0.7 to 5.2, p = 0.015), but the median length of time from seeing a clinician until leaving the department was unchanged (b = 0.6 min/year, 95% CI -1...
Adolescents, Jan 24, 2024
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Foot and Ankle Surgery, 2010
There is no universally accepted method of classification of tibial plateau fractures, with more ... more There is no universally accepted method of classification of tibial plateau fractures, with more than six classification schemes having been described. Of these, the Schatzker and AO/OTA classifications are the most commonly used methods for classifying such fractures. 1,2 There is little information regarding inter- and intra-observer variation when classifying tibial plateau fractures using the Schatzker and AO/OTA classification systems and hence this study was performed.
Erratum: Inter- and intra-observer variation of the Schatzker and AO/OTA classifications of tibial plateau fractures and a proposal of a new classification system (Annals of the Royal College of Surgeons of England (2007) vol. 89 (400-404) 10.1308/003588407X187667)
Annals of The Royal College of Surgeons of England, 2007
Upper limb spasticity surgery in adults: What we learned in 5 years of practicing it
Journal of Musculoskeletal Surgery and Research, 2019
We have been practicing surgical management of adult upper limb spasticity for the past 5 years. ... more We have been practicing surgical management of adult upper limb spasticity for the past 5 years. So far, we have evaluated 20 patients, and we have operated on nine patients with spasticity of the upper limb in Cyprus and the United Kingdom. We aim to present the setup and running of a new service, which is devoted to Surgery for Spasticity of the Upper Limb. We present our structure, organisational processes and service provision as well as our results in the nine cases that had surgical treatment as a part of their management (as well as our preferred techniques). We discuss our outcomes as well as our learning points from these cases. We also believe that selective neurectomy procedures can be very useful in the surgical management of upper limb spasticity. Tendon transfers to augment finger extension have a limited role and provide no significant benefits in adult spasticity cases. In addition, we found that the extensor carpi ulnaris transfer to extensor carpi radialis brevis has in our experience, reliable results regarding concentric wrist extension as well as easier rehabilitation. Furthermore, in severe cases, where no functional improvement is expected, joint fusions have a more predictable outcome. Spasticity reduction surgery does gain ground with the increase in survival of stroke patients as well as traumatic brain injury patients. Therefore, up to date methods for assessing, operating and evaluating postoperatively this category of patients need to be vigorously checked.
Journal of Genetics, 2016
Haploinsufficiency of the short stature homeobox contaning SHOX gene has been shown to result in ... more Haploinsufficiency of the short stature homeobox contaning SHOX gene has been shown to result in a spectrum of phenotypes ranging from Leri-Weill dyschondrosteosis (LWD) at the more severe end to SHOX-related short stature at the milder end of the spectrum. Most alterations are whole gene deletions, point mutations within the coding region, or microdeletions in its flanking sequences. Here, we present the clinical and molecular data as well as the potential molecular mechanism underlying a novel microdeletion, causing a variable SHOX-related haploinsufficiency disorder in a three-generation family. The phenotype resembles that of LWD in females, in males, however, the phenotypic expression is milder. The 15523-bp SHOX intragenic deletion, encompassing exons 3-6, was initially detected by array-CGH, followed by MLPA analysis. Sequencing of the breakpoints indicated an Alu recombination-mediated deletion (ARMD) as the potential causative mechanism.
Injury Extra, 2008
features in the bone marrow indicating depletion of the stem cell pool after major trauma, which ... more features in the bone marrow indicating depletion of the stem cell pool after major trauma, which we hypothesise will be associated with changes in related colony stimulating factors (GM-CSF and G-CSF) and the functional efficacy of circulating neutrophils and monocytes. Methods: Study population groups: (1) Major blunt trauma patients (ISS > 18) with pelvic, acetabular or femoral shaft fractures (N = 9, mean ISS 29 (27-41)). (2) Isolated pelvic, acetabular or femoral shaft fractures. (3) Surgical controls undergoing pelvic or femoral shaft surgery without an acute injury. Blood samples were obtained at admission, the time of fracture surgery (along with bone marrow) and at 2 and 5 days post-op. Results: The percentage CD34+ cells (immature progenitors) were significantly reduced in the bone marrow of major trauma patients as previously described, and significantly more immature CD35− cells were found in the circulation. These proved unable to transmigrate in response to IL-8 in vitro. Circulating levels of GM-CSF and G-CSF were suppressed after major trauma. Extensive transfusion was required with a median of 8 (range 2-16) units required prior to fracture fixation. Neutrophil respiratory burst activity remained elevated throughout this period, while monocyte HLA-DR expression was reduced. Discussion: The dysfunction of circulating neutrophils and monocytes is in keeping with previous data. Suppressed GM-CSF and GCSF levels were unexpected and may be related to the failure of the bone marrow to restore its progenitor pool and thus produce dysfunctional leukocytes. Therapeutic manipulation of this may prove possible.
Foot & Ankle International, 2009
Background: The poor vascularity of tendons is a major factor in their limited healing capacity. ... more Background: The poor vascularity of tendons is a major factor in their limited healing capacity. The aim of this study was to assess the effect of Platelet Rich Plasma (PRP) on angiogenesis during tendon healing. Materials and Methods: Forty-eight skeletally mature New Zealand White rabbits were used. The Achilles tendon was transected transversely and 0.5 ml of PRP was injected into the tendon mass on each side of the incision on both limbs. The injection in the control group consisted of saline. Six animals from each group (12 tendons each) were sacrificed after 1, 2, 3, and 4 weeks following treatment. Three sections from each Achilles were stained with hematoxylinosin for microscopic examination. Further three sections were immunostained with a monoclonal antibody against CD31 (Daco Co), followed by image analysis to count new vessel numbers and statistical analysis was performed. Results: There was significantly more angiogenesis in the PRP group compared to the control group d...
Optimisation of Screw Thread Length and the Effect on Union in Subtalar Fusion
Introduction: An ideal screw for subtalar fusion would be designed such that screw thread length ... more Introduction: An ideal screw for subtalar fusion would be designed such that screw thread length in the distal bone would be maximised but without distal perforation, whilst having no threads across the fusion site that would inhibit compression. Method: Radiographs and clinical assessment of 100 patients who had undergone subtalar fusion were analysed and correlated with the presence or absence of non-union. In addition, using the characteristics of the inserted screw as a scaleable marker, it was calculated what would have been the optimum length of screw thread in order to maximise screw thread length in the target bone whilst preventing the screw threads being across the fusion site. Results: There is no correlation between the presence of screw threads across the fusion site and non-union. Currently available screws have thread lengths that are either too long (breaching the fusion site) or too short for ideal fixation and we propose a different thread length to those currently...
Corrigendum to: When should old therapies be abandoned? A modern look at old studies on topical ampicillin [Journal of Infection 47 (2003): 203–209]
Journal of Infection, 2008
Strategies in trauma and limb reconstruction (Online), Jan 13, 2015
We report our experience in treating victims of the recent earthquake disaster in Pakistan. Our e... more We report our experience in treating victims of the recent earthquake disaster in Pakistan. Our experience was based on two humanitarian missions to Islamabad: one in October 2005, 10 days after the earthquake, and the second in January 2006. The mission consisted of a team of orthopaedic surgeons and a second team of plastic surgeons. The orthopaedic team bought all the equipment for application of Ilizarov external fixators. We treated patients who had already received basic treatment in the region of the disaster and subsequently had been evacuated to Islamabad. During the first visit, we treated 12 injured limbs in 11 patients. Four of these patients were children. All cases consisted of complex multifragmentary fractures associated with severe crush injuries. All fractures involved the tibia, which were treated with Ilizarov external fixators. Nine fractures were type 3b open injuries. Eight were infected requiring debridement of infected bone and acute shortening. During a sec...
Introduction: We present the long term results in 204 cases of Hallux Valgus deformity correction... more Introduction: We present the long term results in 204 cases of Hallux Valgus deformity correction using a modified Mitchell’s osteotomy. Methods: 168 patients (204 feet) that had Mitchell’s osteotomies between 1986 and 2001 were recalled for clinical and radiological evaluation. The patients had hallux valgus angles of up to 50o and intermetatarsal angles of up to 20o. They all had a modified procedure using two crossed Kirschner wires to fix the capital fragment into plantar displacement and angulation. Lateral soft tissue release was performed when deemed necessary during the procedure. Mild to moderate arthritis of the 1st metatarsophalangeal joint was not a contraindication. The AOFAS scores as well as any complications were recorded and the Xrays were used to measure hallux valgus and intermetatarsal angles. Mann-Whitney U test was used to analyze data. Results: The mean follow up was 12.9 years. The mean AOFAS score improved from a preoperative of 49.6 to a postoperative of 87...
The Nerve Supply of the Supinator Muscle Revisited: An Anatomical Study That Adds to the Understanding of Radial Tunnel Syndrome
A significant number of patients return with persistent symptoms following surgical release of th... more A significant number of patients return with persistent symptoms following surgical release of the posterior interosseous nerve for radial tunnel syndrome. The aim of this study was to attempt to explain this fact in anatomical terms by defining the anatomy of the posterior interosseous nerve and its branches in relation to the supinator muscle and arcade of Frohse. Using standard dissection tools 20 preserved cadaveric upper limbs were dissected. The radial nerve and all its branches within the radial tunnel were exposed and a digital calliper was used to measure distances. The bifurcation of the radial nerve to posterior interosseous nerve and superficial sensory branch occurred at a median distance of 4.35mm proximal to the elbow joint-line. The bifurcation was proximal to the joint-line in 11 cases, at the level of the joint-line in one case and distal in eight cases. There was a range of 0–5 branches to the supinator originating proximal to the entry point of the posterior inte...
Incidence of Cervical Rib in the White British Population and Direct Comparison with the Incidence in the Asian Population: A Radiological Study
A number of studies have looked at the incidence of cervical rib in various ethnic groups, but ha... more A number of studies have looked at the incidence of cervical rib in various ethnic groups, but have a number of limitations. This is the first large scale study looking at the incidence in White British with direct comparison to the Asian population. A total of 1545 consecutive cervical spine radiographs performed for any reason were collected and reviewed. 5.9% of White British and 24.9% of Asian patients had evidence of cervical rib. This was statistically significant (p be considered in the assessment of patients with symptoms of thoracic outlet syndrome, taken into account during review of cervical spine radiographs and included in anatomy textbooks in the future.
Picture Quiz: Falling on an outstretched arm
BMJ
A 6 year old boy attended the emergency department with an isolated injury to his left elbow afte... more A 6 year old boy attended the emergency department with an isolated injury to his left elbow after falling on his outstretched left arm. On examination, the left elbow joint was swollen and clinically deformed with diffuse tenderness. The skin was intact and there was no neurovascular deficit in the left upper limb. We x rayed the elbow (figure). X ray of the boy's elbow 1. What does the x ray film show? 2. What should the assessment of such an incident include? 3. What is the classification of supracondylar fractures of the humerus? 4. What are the potential complications of supracondylar fractures? 5. How should this fracture be managed? 1. The x ray film shows a displaced supracondylar fracture of the left humerus with the distal fragment of the humerus displaced posteriorly. 2. Assessment should include a quick general evaluation of the patient to ensure that the airways are patent, breathing is …
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2006
The aim of this study was to compare intra-articular anesthesia alone versus general anesthesia w... more The aim of this study was to compare intra-articular anesthesia alone versus general anesthesia with regard to ease of the procedure, level of postoperative pain, and patient satisfaction when partial meniscectomy is anticipated. Methods: We prospectively randomized to general anesthesia or to intra-articular anesthesia 107 patients who were about to undergo knee arthroscopy, in whom partial meniscal resection was anticipated on the basis of clinical or radiologic grounds. Technical difficulty of the procedure, level of postoperative pain and nausea, and overall patient satisfaction were assessed. Results: The ease of obtaining arthroscopic views, the adequacy of these views, and the ease of performing partial meniscal resection or another procedure were similar in both groups according to scores assigned by the operating surgeon. Pain at 6 hours postoperatively was significantly less in the intra-articular anesthesia group but was similar in the 2 groups at 24 and 48 hours. Patients who were given intra-articular anesthesia reported higher satisfaction rates in understanding the underlying disease of the knee. Conclusions: We propose that intra-articular anesthesia alone can be effectively used in knee arthroscopies in which partial meniscal resection is anticipated. Level of Evidence: Level I, high-quality randomized controlled therapeutic trial.
The first description in the literature, of a complication during the extraction of a retrograde expandable intra-medullary nail in three patients
Trauma Case Reports, 2016
Injury-international Journal of The Care of The Injured, 2005
Has the assessment of isolated ankle injuries altered since 1993?
Emergency medicine journal : EMJ, 2005
Performance of emergency departments in England and Wales has declined in recent years. Data from... more Performance of emergency departments in England and Wales has declined in recent years. Data from the authors' department has shown that junior doctors now see fewer patients and spend longer over their assessment than was the case previously. This study aimed to determine how the assessment of patients with isolated ankle injuries changed over an 11 year period. A retrospective case note review was conducted. Data regarding the duration of assessment, clinical information recorded, investigations, and treatments were retrieved. During the period studied 13 555 patients presented with isolated ankle injuries; case notes of 550 of these patients were reviewed in the present study. Linear regression demonstrated that the median length of time from arrival in the department until seen by a clinician increased (b = 3.0 min/year, 95% CI 0.7 to 5.2, p = 0.015), but the median length of time from seeing a clinician until leaving the department was unchanged (b = 0.6 min/year, 95% CI -1...