An Evidence-Based Approach to Multi-Ligamentous Knee Injuries

Multi ligament knee injuries (MLKIs) are highly complex injuries with associated complications and often present with difficult management strategies. MLKIs may affect the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (or posteromedial corner (PMC)), and lateral collateral ligament (or posterolateral corner (PLC)) in addition to other structures including the menisci, common peroneal nerve, and popliteal artery. MLKIs are highly associated with the male sex and are commonly seen in high-velocity motor vehicle accidents and low-velocity sports injuries. Given the multiple planes of movement in the knee and various primary and secondary stabilizers throughout those planes, there is great heterogeneity in an injury pattern and most involve the ACL and PCL. Initial evaluation of this injury includes assessment of lower extremity sensation, distal pulses, and ankle-brachial index (ABI). If vascular compromise is suspected, computed tomography angiography (CTA) or magnetic resonance angiography (MRA) are indicated to evaluate the vasculature. As opposed to CTA, MRA offers visualization of the soft-tissue structures that are commonly damaged in MLKIs. Initial management typically includes closed reduction of the knee with subsequent external fixation. Classification systems guide initial assessments; however, further management is unclear and leads the surgical team to decide the best, individualized management option for each patient. As a result, optimal surgical and postoperative treatment options remain complicated, and clinical outcomes remain difficult to predict. The purpose of this review is to consolidate the most up-to-date practices of the diagnostic workup, management, and treatment of MLKIs.

Non verbal language in mothers with malnourished infants. A pilot study

Maternal non verbal language (NVL) includes all gestural manifestations of the mother towards her infant which bear an emotional connotation. This study compares NVL expressiveness of mothers with malnourished and with healthy infants in a population of low socioeconomic level. Forty mother/infant dyads: 20 mothers with malnourished infants and 20 with healthy infants were studied. Mothers with malnourished infants had low degree of NVL expressiveness (90%) and low personal satisfaction with their family life (70%).

Obstetrical caudal anesthesia in a community hospital. A satisfactory plan

The development of a program to provide complete anesthesia coverage for obstetrics in a community hospital was undertaken as a prospective project which emphasized continuous caudal techniques. Mutually acceptable guidelines were formulated by a group of anesthesiologists and the Department of Obstetrics and Gynecology. A computerized study involving 3,500 labor patients was carried out to thoroughly evaluate the experience over 16 months. The data confirmed the feasibility, safety and wide acceptance of the program. Major complications were few and the anesthesia service to patients was excellent.