1/3. Fractured lateral epicondyle with associated elbow dislocation.We describe a case series involving a very unusual injury in children, i.e. a Milch 1 fracture of the lateral condyle with an associated dislocation of the elbow. This fracture configuration is normally stable as the intact capitellotrochlear groove serves as a lateral buttress for the coronoid-olecranon ridge of the ulna. In this series, however, each patient had an associated dislocation. These injuries usually present as a clinical dislocation and if the elbow is manipulated before radiographic imaging, the fracture line can be difficult to see on the post-reduction films. We recommend that all patients with a dislocated elbow should have elbow stability assessed under general anaesthesia, because a missed lateral condylar injury can lead to abnormalities in carrying angle, epiphyseolysis or an unstable elbow.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/3. Anaesthesia for a patient with Down's syndrome and Eisenmenger's complex.A patient with Down's syndrome and Eisenmenger's complex presented for orthopaedic surgery on the elbow under general anaesthesia. During pre-oxygenation, in order to prevent a subsequent fall in systemic vascular resistance, metaraminol 1 mg was administered intravenously. The patient immediately developed bradycardia, mild hypertension and became deeply cyanosed. His condition rapidly improved after atropine 0.6 mg was given intravenously. Following induction of anaesthesia with thiopentone and tracheal intubation facilitated by suxamethonium, anaesthesia was maintained by mechanical ventilation of the lungs with nitrous oxide and oxygen (40%) with intravenous increments of fentanyl for analgesia and pancuronium for muscle relaxation; residual neuromuscular blockade was reversed with neostigmine. The patient made an eventful recovery. Although general anaesthesia is tolerated by patients with Eisenmenger's complex, powerful vasoactive drugs should not be administered unless specifically indicated.- - - - - - - - - - ranking = 4keywords = anaesthesia (Clic here for more details about this article) |
3/3. Simultaneous anterior dislocation of the shoulder and fracture of the ipsilateral humeral shaft. Two case reports.Two patients with anterior dislocation of the shoulder and ipsilateral fracture of the shaft of the humerus have been studied and the mechanism of their injuries has been documented. Closed reduction of the dislocations was performed under anaesthesia during surgery for humeral fixation with a dynamic compression plate. The fractures and dislocations healed without any problems at 6 to 9 months postoperatively. At recent follow-up, one patient had returned to work and regained normal mobility. The other patient had the sequelae of a brachial plexus injury. The literature on this subject is reviewed.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |