Study Design: Repeated Measures.

Objectives: To determine the short term impact of cold water immersion on sensory and vascular functions in patients with Distal Radius Fracture (DRF) and compare responses in the injured and uninjured hands.

Background: Cold exposure is used to assess neurovascular function. Cold is also used as therapeutic agent to reduce pain and swelling. There is a scarcity of trials that have looked at the impact of cold exposure in patients with DRF.

Methods: Twenty patients with DRF, aged 18 to 65 yrs. were recruited after cast removal. All patients underwent Immersion in Cold water Evaluation (ICE) which consisted of 5 min of hand immersion in water at 12°C. Skin Blood Flow (SBF) in hands, Skin Temperature (S Temp.) in index and little fingers and sensory Perception Thresholds (sPT) at 2000Hz (for Aβ fiber) and 5 Hz (for C fiber) were obtained from ring finger, before ICE, immediately after (0 min, 1 min) and 10 min later. Differences were analyzed using repeated measures.

Results: In the DRF hand, SBF increased immediately (Mean Difference = -42.2 A.U), at 1 min (-35 A.U) and 10 min after ICE (-1 A.U). Skin Temp. In index and little fingers decreased immediately after ICE (9.9°C and 9.1° C) and did not return to baseline by 10 min (4°C and 4.1°C). ICE had no effect on sPT at 5 Hz (p>0.05). There was no difference between the DRF and uninjured hand on all measures(p>0.05) except for the sPT at 2000Hz, which remained high on the DRF side for up to 10 min (-1.8 m. A).

Conclusion: Normal cold responses consistent with ‘hunting reaction’ were observed after ICE in both hands. Aβ fibers on DRF side became less sensitive after ICE. These findings suggest that a brief immersion in cold water does not produce any adverse events associated with cold exposure.

To ensure the possible accelerated osteogenesis of long bone fractures in patients with concomitant spinal cord injury and to investigate the mechanism causing it with the understanding of a possible neuro-hormonal cause, a hormonal bioassay of the blood of 21 of these patients was measured in the prospective controlled study and compared to 20 patients with only spinal cord injuries, 30 patients with only long bone fractures, and 30 healthy volunteers.

The study results showed that Long bone fractures in patients with associated acute traumatic spinal cord injury of quadriplegia or paraplegia heal more expectedly, faster and with exuberant florid union callus (P>0.001) and showed statistically significant higher levels of parathyroid hormone and growth hormone (p<0.005) and normal corticosteroids levels. Patients with long bone fractures only showed consistent and statistically significant higher level of noradrenaline and adrenaline hormones compared to patients with spinal cord injury alone or associated with long bone fractures (p<0.001). Leptin hormone shows statistically significant consistent decrease in patients with spinal cord injury and concomitant long bone fractures compared to healthy subjects (p<0.001). We believe, according to the results of this study that bone healing is accelerated in long bone fractures in patients with associated spine fractures and spinal cord injuries. We also can conclude that bone healing has a central neuronal control and a combined neuro- hormonal mechanism with a relative inhibition of the sympathetic nervous system is a possible cause of accelerated healing of long bone fractures in patients with associated spinal cord injury.

Background: Preoperative arthroscopic examinations were carried out in patients with varus deformity among those with osteoarthritis of the ankle caused by malalignment, and to assess the severity of the disease on the basis of the arthroscopic findings, and the associations of these findings with X-ray findings and the indications for supramalleolar osteotomy were evaluated.

Methods: A total of 57 joints in 56 patients were investigated, and the mean follow-up period was 4 years. The proportion of the surface area of the ankle that had become hardened into an eburnation was classified according to a five-grade scale on the basis of preoperative arthroscopy: Grade 1 indicated fibrillation of the articular cartilage alone with no evident eburnation; Grade 2, eburnation was limited to the medial malleolar articular surface; Grade 3, eburnation extended across the medial shoulder of the talus, but covered <25% of the talocrural joint; Grade 4, eburnation covered ≥25% but <50% of the talocrural joint; and Grade 5, eburnation covered ≥50% of the talocrural joint. The surgical procedure used was lateral closing wedge osteotomy, and assessments were carried out using Takakura, et al.’s clinical score and Tanaka, et al.’s radiographic grading system.

Results: Initially, 3 joints were Grade 1, 19 were Grade 2, 15 were Grade 3, 16 were Grade 4, and 4 were Grade 5. Postoperatively, 30 joints were Grade 1, 14 were Grade 2, 7 were Grade 3, 4 were Grade 4, and 2 were Grade 5. Clinical scores showed an improvement from 63.9±11.2 points preoperatively to 81.9±13.2 points postoperatively.

Conclusion: Patients who were classed as Grade 3 or below by preoperative arthroscopy showed improved clinical outcomes and radiographic grades. To assess the proportion of cartilage, that may be affect postoperative outcomes, preoperative arthroscopy should be done prior to the supramalleolar osteotomy.

Background: Bipolar sealer technology provides a continuous saline flow effectively maintaining tissue temperatures below 100°C and theoretically leading to decreased charring of soft tissue. We investigate whether this results in less pain and reduced narcotic consumption in patients following Total Knee Arthroplasty (TKA).

Methods: A retrospective review of prospectively collected data of 100 primary unilateral TKAs were divided into two historical cohorts. Each Cohort consisted of 50 consecutive patients before and after switching from a monopolar Bovie to the bipolar sealer. All other perioperative variables such as multimodal protocols, no use of tourniquet, surgical technique or perioperative mobilization were identical. All patients were discharged the next day 24 hours within surgery. Pain measurements using a Visual Analog Scale (VAS) and narcotic consumption were retracted from the longitudinal medical records and analyzed for the day of surgery, day of discharge and in total.

Results: Bipolar sealer patients reported significantly lower pain scores and narcotic usage. Day of surgery pain levels were comparatively reduced from a VAS of 4.1 to 2.7 (p < .05) and day of discharge pain levels were reduced from 4.5 to 3.1 (p < .0001), reductions of 33% and 31% respectively. Total ME administered was reduced from 35.9 mg to 26.2mg (p < .05). The preclinical characteristics of each patient cohort were not associated with the pain outcomes nor ME consumption.

Conclusion: Our preliminary trial revealed a significant reduction in pain levels and narcotic consumption in patients following unilateral TKAs with bipolar sealing technology compared to the use of the standard Bovie. This study suggests that this technology may decrease pain and narcotic consumption in patients using the exact same perioperative management. The future will show whether the increased cost of this technology will lead to a more widespread use.