To investigate any intra-operative alteration in management in those patients who had a pre-operative echocardiogram, a retrospective study for one year (March 2004 to February 2005) was carried out at West Middlesex University Hospital. Total number of 176 hip fractures, echocardiogram was done pre-operatively in 22 patients (12.5%). The request for echo was given by the anaesthetic team in 18/22 patients, the commonest reason for request being a cardiac murmur detected clinically in 20/22 patients. There was a delay in surgery more than 24 hours in 17/22 patients who had an echocardiogram (77%) compared to a 38% delay in patients who did not. The echocardiogram findings showed significant aortic stenosis in 4/22 (18%). There was no cancellation of surgery due to echocardiogram findings Five had general anaesthetic. There was alteration in intra-operative management in two out of the 22 patients (8%) Invasive arterial monitoring was used in those two patients. None had intra-operative complications or ITU/HDU care post-operatively. Post-operatively 6/22 developed complications. 15/22 patients had a delay in discharge (68%) of more than 21 days compared to the 41% delay in patients who did not have an echocardiogram. We had a mortality rate of 22.7% (5/22) in these patients at 1 month compared to a mortality rate of 12% in patients without echocardiogram.Aim
Results
Percutaneous A1 pulley release is being increasingly used as an alternative to open surgical release and injection of local steroids for the treatment of the trigger digit. We treated 43 patients, average age 57 years (range12-78). All trigger digits were grade III-IV (Quinnell classification). A mean duration of pre-operative symptoms was 7.3 months (range 2-13 months). A percutaneous release was performed with a 19-gauge hypodermic needle under local anaesthesia in the outpatient setting. All patients were evaluated with respect to clinical resolution of symptoms and general satisfaction. We report a 97% successful release and only one case of incomplete release. A result in terms of abolishing triggering was immediate and patient acceptance was excellent. By two weeks, all the patients had no pain at the operative site. After a mean follow-up of 30.2 months (range12-50), there had been no recurrences. There were no digital nerve injuries, flexor tendon injuries, and infections. The percutaneous release is a safe and effective technique, which provides significant cost savings. The time from onset of symptoms and grading prognostically is significant and affects the treatment outcome. We recommend the percutaneous technique for typical cases of trigger finger with a palpable nodule and reproducible mechanical triggering. This technique can be the treatment of choice for the established trigger finger (grade III and IV) with symptoms of more than few months' duration. The open technique is reserved for complicated cases such as florid tenosynovitis, locked digit, failed percutaneous release or those involving the thumb.
