Percutaneous tennis elbow release under local anaesthesia

Introduction:

When the non-operative treatment of tennis elbow fails to improve the symptoms a surgical procedure can be performed. Many different techniques are available. The percutaneous release of the common extensor origin was first presented by Loose at a meeting in 1962. Despite the simplicity of the operation and its effectiveness in relieving pain with minimal scarring this procedure is still not widely accepted. This study presents the long-term results of percutaneous tennis elbow release in patients when conservative measures including local steroid injections have failed to relieve the symptoms.

Patients and Methods:

Percutaneous release of the extensor origin was performed in 24 consecutive patients (seven male and seventeen female), providing 30 elbows for this study. The age of the patients ranged from 26 to 71 years with mean age of 55 years. The technique involved a day case procedure in the operating theatre using local anaesthesia without the need for a tourniquet. The lateral elbow was infiltrated with 5mls 1% lignocaine and 5mls 0.5% bupivicaine with 1:200,000 adrenaline. All operations were performed by the senior author. The patients were assessed post operatively by using DASH (disabilities of arm, shoulder and hand) score and Oxford elbow scores. The mean follow up period was 36 months (1-71months).

Results:

Twenty one patients returned the DASH and Oxford elbow questionnaires. Four patients were lost in the follow up. The post operative outcome was good to excellent in most patients. Eighty seven percent of patients had complete pain relief. The mean post-op DASH score was 8.47 (range 0 to 42.9) and the mean Oxford elbow score was 42.8 (range 16 to 48). There were no complications reported. All the patients returned to their normal jobs, hobbies such as gardening, horse riding and playing musical instruments.

Conclusion:

In our experience Percutaneous release of the epicondylar muscles for humeral epicondylitis has a high rate of success, is relatively simple to perform, is done as a day case procedure and has been without complications. Percutaneous release is a viable treatment option after failed conservative management of tennis elbow.

Removal of Co2+ ions from aqueous solution by cation exchange sorption onto NiO

Batch adsorption technique was used to study the adsorption of cobalt on NiO. The aim of this work was to examine the effect of pH, concentration and temperature on the ion exchange removal of Co2+ from aqueous solution by the NiO surface. We used Langmuir model to interpret the adsorption data. The Kurbatov-type plots were tested to determine the adsorption mechanism. The kinetics of Co2+ adsorption on NiO was best described by film diffusion model. A well-known thermodynamic equation was used to assess the enthalpy and entropy of the system. The thermodynamic data were indicative of the spontaneous nature of the endothermic sorption process of Co2+ onto the NiO.

Is there a Consensus in the Management of Distal Radial Fractures?

This unique postal survey was setup to assess the agreement on treatment options in displaced distal radius fractures and whether or not there existed a consensus amongst the surgeons contacted. With this in view we contacted 244 surgeons and 166 completed answers were received.We chose two common examples of displaced distal radius fractures. Case one was a 38 year old teacher with a closed, displaced extra-articular fracture (Frykman type II) of her left non-dominant hand and case two was a 42 year old carer, with a closed, displaced intra-articular fracture (Frykman type VII) of her right dominant wrist. There was a questionnaire included with these radiographs.In the first case, 82 (49%) surgeons favoured MUA + K-wiring, 47 (28%) favoured volar plating and 14 (8%) an external fixator. In the second case, 28 (17%) surgeons favoured MUA + K-wiring, 53 (32%) advocated volar plating and 33 (20%) an external fixator. Furthermore surgeons with specialist Upper limb interest were more likely to apply a volar plate (63% in either case) whilst the surgeons with general or other areas of expertise (18% in first case and 23% for second case).In conclusion there is no consensus among the Orthopaedic surgeons in treating displaced distal radial fractures. A multicentered randomized clinical trial would help elucidate the best treatment options.

Chromium (III) removal by weak acid exchanger Amberlite IRC-50 (Na)

Chromium (III) sorption on a weakly macroporous cation exchanger Amberlite IRC-50 (Na) is studied as a function of time and temperature. The rate constant values for chromium (III) sorption are calculated both for film and particle diffusion processes. The temperature is found to have a positive effect on both the diffusional processes. The high values of energy of activation confirm the particle diffusional nature of the process. The pH changes in the system show a competition between the Cr(OH)(2+) and H(+) ions for the exchange sites of the adsorbent. Equilibrium data are explained with the help of Langmuir equation. Various thermodynamic parameters (DeltaH degrees , DeltaS degrees and DeltaG degrees) from chromium (III) exchange on the resin are calculated.

IMHS in peritrochanteric fractures

Internal fixation of fractures of the proximal femur is one of the most common trauma operations in the UK. While stable fractures have been successfully treated with sliding hip screws for many years with a low rate of complications, there has been much debate about the right choice of implant for the treatment of unstable and sub-trochanteric fractures. We present a series of 45 patients with inter- and sub-trochanteric fractures and pathological lesions who were treated with the Intramedullary Hip Screw (IMHS). All notes and radiographs were reviewed and there was an emphasis on the quality of reduction and the position of the metalwork. The commonest postoperative complication was superior cut-out of the sliding screw in four patients (8.8%). Varus position after reduction and superior screw position were present in these patients. Two of the patients were converted to IMHS fixation after previous failure of dynamic hip screw (DHS)/dynamic condylar screw (DCS) fixation. All four patients were treated non-operatively until the fractures were healed. We conclude that IMHS fixation is a viable option for unstable and pathological inter- and sub-trochanteric fractures of the femur. Varus reduction and superior position of the sliding screw have to be avoided. In revision cases there is a high rate of failure. (Hip International 2005; 15: 27-32).

Success of cannulated screw fixation of subcapital neck of femur fractures

In this study we retrospectively reviewed 251 patients who had internal fixation for neck of femur fracture using cannulated screws. Twenty were lost to follow-up or died soon after surgery. The fracture was displaced in 114 (49.9%) and undisplaced in 117 (50.6%) patients. There were 65 males and 171 females with an average age of 75.7 years. Average follow-up was 12 months. Of the 117 patients with undisplaced fractures 75 (64.1%) healed uneventfully. Further surgery was performed in 21 (17.9%) patients. In the 114 patients with displaced fractures, satisfactory reduction was achieved in 74 patients and of these 54 had good screw placement. Fifty-one (44.7%) patients healed uneventfully. Twenty-two (20%) of the 114 displaced fracture patients required further surgery. Forty (35%) had an unsatisfactory reduction and, of these, 26 (65%) had poor screw placement. Re-operation rates were 17.9% and 20% respectively. The rate of AVN was similar in both fracture types (10.3%-11%), but the rate of non-union was four times higher (2.6%-11.5%) in displaced subcapital fractures. The most important factors within the control of the surgeon that influence the rate of healing are adequate reduction and correct placement of the screws. In this series the reduction was unsatisfactory in 40 (35%) cases of the displaced NOF fractures, and the screws were incorrectly positioned in 46 (40.4%) of the 114 displaced fractures compared with 11 (9.4%) of the 117 undisplaced fractures. This highlights the importance of adequate reduction to enable correct screw placement in displaced fractures. (Hip International 2004; 14: 244-8).

Unusual presentation of sciatica in a 14-year-old girl

The sciatic nerve can be compressed by a variety of causes, while intervertebral disc herniation is the most common cause of sciatica [Surg. Neurol. 46 (1996) 14], other documented causes include, infection, neoplasm, degenerative disease of a spine, congenital anomalies and traumatic posterior hip dislocation [BMJ 287 (1983) 157]. Sciatic neuropathy in children is uncommon. We present an unusual case of sciatic nerve compression in a 14-year-old-girl that was caused by an avulsion fracture of the ischial tuberosity. The compression was relieved by surgical excision of the avulsed ischial tuberosity.

Influence of colchicine on pulmonary silicotic fibrogenesis in rats

With an aim to evaluate the antifibrotic action of colchicine in experimental model of pulmonary silicosis, the effect of colchicine on developing and developed pulmonary silicosis induced by quartz was studied in rats in vivo and on alveolar macrophages exposed to quartz particulates in vitro. A progressive increase in wet and dry weight of lungs exposed to quartz dust alone, and quartz dust and colchicine injected orally was investigated. An increase in collagen contents, with lapse in time, in animals exposed intratracheally to quartz dust, or exposed similarly to quartz dust but receiving colchicine simultaneously through oral route was observed. A blindfold evaluation of histological sections of lungs of silicotic animals with or without colchicine administration during development of lesions did not reveal any difference between two groups of silicotic rats. Administration of colchicine for 4 weeks after the lesions were developed neither inhibited nor retarded the laying down of collagen. The studies were extended to investigate the effect of colchicine on quartz-induced alveolar macrophage cytotoxicity. The presence of varying concentrations of colchicine in the culture medium did not significantly alter cytotoxic potential of quartz. The results reveal that colchicine administration during the development of and on developed silicosis does not significantly alter pathogenesis of silicotic lesions. At the cellular level colchicine does not modulate quartz-induced alveolar macrophage cytotoxicity, believed to be a significant event for the onset of pulmonary silicotic fibrogenesis.