A Controlled Clinical Trial of Postoperative Hand Elevation at Home Following Day-Case Surgery

Although elevation of the upper limb is considered valuable for the prevention and of the reduction of swelling following major surgery or severe injuries to the hand, it is not clear how much elevation, if any, is required following minor surgery such as carpal tunnel decompression. We investigated this by randomizing patients undergoing carpal tunnel decompression into two groups – one having high elevation at home and one being treated with a simple sling. Volumetric analysis of the swelling of the hand 5 days postoperatively showed no significant difference between the two groups. In the trial group, the mean increase in volume of the operated hand was 11 ml (95% CI +4 to +17) or 2.7%. In the control group, the mean swelling was 13 ml (95% CI +4 to +21) or 3.6%. The findings of this study do not support the use of routine high arm elevation following day-case surgery of the hand.

The clinical indications for plain radiography in acute knee trauma

OBJECTIVES

to assess the key symptoms and physical signs in the acutely injured knee that are significantly associated with fracture and utilise these to develop an algorithm for the use of radiography in acute knee trauma.

DESIGN

retrospective review of all acute knee injuries presenting to the accident and emergency unit at a District General Hospital over a 6-month period in 1998 (over 500 cases). After exclusions, a study group of 370 eligible adults was obtained. These patients were reviewed for the key symptoms and physical signs, and radiological evidence of fracture.

OUTCOME MEASURES

the X-ray films were interpreted by a consultant radiologist. Of those patients on whom radiographs were not performed, follow up was assessed by a review of any re-attendance to the A&E department.

RESULTS

there was a statistically significant correlation, using chi-square (Mantel-Haentzel) and linear regression analysis, between the presence of a fracture and each of the following variables: age, non-weightbearing in the department (p<0.05), haemarthrosis, point bony tenderness, effusion (p<0.001).

CONCLUSION

these key symptoms and physical signs may form the basis of an algorithm for examining knees radiologically, with acceptable positive and negative predictive values. (This is currently being tested prospectively).