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This randomized double-blind study compared the analgesic efficacy and tolerability of intramuscular lornoxicam and tramadol in 76 patients with moderate to unbearable pain following arthroscopic reconstruction of the anterior cruciate ligament using the patella bone-tendon-bone technique. Patients receiving a single dose of lornoxicam 16 mg experienced significantly greater total pain relief than patients receiving tramadol 100 mg over the following 8 hours. Lornoxicam had greater analgesic efficacy than tramadol in patients with moderate baseline pain but was of equivalent efficacy in those with severe/unbearable baseline pain. Fewer patients in the lornoxicam group required rescue medication (58% vs. 77%, respectively). Patients' global impression of efficacy showed lornoxicam to be superior to tramadol with 82% and 49% of patients, respectively, rating treatment as good, very good, or excellent. Following multiple-dose administration of lornoxicam (8 mg tid) or tramadol (100 mg tid) for 3 days, efficacy profiles similar to those following a single dose were obtained. Thus, slightly fewer patients in the lornoxicam group required rescue medication, and patients' global impression of efficacy again favored lornoxicam. Adverse events were reported by 38 of the 76 patients and were mainly mild to moderate in severity. Significantly fewer patients reported one or more adverse events with lornoxicam than with tramadol (14 vs. 24, respectively). Thus, intramuscular lornoxicam offers a useful alternative to tramadol for the treatment of moderate to severe postoperative pain.

In a prospective study of Colles' fractures, 100 patients with Older type 1 and 2 fractures were randomized in two groups. One group was immobilized for 3 weeks and the other one for 5 weeks. Both groups were immobilized with a below-elbow plaster splint. At 1 year follow-up, there were 73 patients with 74 fractures. Dorsal angulation, radial length, wrist motion, grip strength and pain were measured. There was no significant difference in the measured parameters in the two groups. We found that 3 weeks of immobilization is a satisfactory treatment for Older type 1 and 2 Colles' fractures.

We compared the diagnostic and predictive value of magnetic resonance imaging (MRI) and clinical findings with arthroscopy in 61 knees in a prospective study. In meniscal tears, the accuracy and positive predictive value of MRI was found to be nearly twice that of clinical examination. The sensitivity, specificity, and negative predictive value of MRI were comparable to the figures found in other studies. We recommend MRI as a clarifying diagnostic tool when a clinical examination indicates a lesion of the meniscus. In our study, the clinical relevance of MRI in anterior cruciate ligament lesions and especially in cartilage lesions was more doubtful. The combination of clinical and MRI findings would reduce the number of blank arthroscopies to 5%. MRI is a valuable diagnostic tool in planning the type of anesthesia and treatment, and could significantly reduce the need for a second arthroscopy.

Stable lateral malleolar fractures can be treated with dynamic braces and early mobilization. In a randomized clinical trial, 66 patients with supination-eversion stage II fractures were treated with Aircast Air-Stirrup ankle braces or DonJoy R.O.M.-Walker braces. Average bracing time was 5 weeks, and average time until return to work was 6 weeks. At 4 weeks, 70% to 80% of patients were able to walk without pain. Subjective satisfaction with comfort and ease of use was significantly higher with Aircast, although it was high in both groups. Pain relief and an inflammatory score were significantly better in the R.O.M.-Walker group after 4 weeks. Three months after injury, no differences were observed in grade of ambulation, pain, swelling, range of motion, or inflammatory score. Both braces can be recommended.

An assessment of the strain on the tympanic membrane caused by diving was performed using impedance measurement of the middle ear in 21 untrained young men going through a scuba-diving training programme (scuba, self-contained under-water breathing apparatus). Tympanometry was carried out just before and after diving. The divers made 104 dives between them (median 5 each, range 2-7) at depths from 2 to 12 m (median 6 m). The results showed a significant increase in middle ear compliance on diving. The increase in compliance was significant at different depths, was transient, and fell to the initial level between the dives. We conclude that the strain exerted on the tympanic membrane and middle ear from barotrauma due to diving results in a reversible impairment of the recoiling capacity of the elastic fibrils of the tympanic membrane. This transient increase in compliance, we think, is the first measurable change in elasticity of the tympanic membrane. If barotrauma continue the changes could be irreversible.

One hundred patients aged 18-49 yr, undergoing elective arthroscopy of the knee joint, were allocated randomly to either spinal anaesthesia using a 29-gauge spinal needle or general anaesthesia. Dural puncture was considered difficult in 18% of the patients receiving spinal anaesthesia. In three patients (6%) it was necessary to supplement the spinal anaesthetic with general anaesthesia. Spinal and general anaesthesia were otherwise uneventful in all patients. The incidence of postoperative headache was similar in the two groups. One patient developed post dural puncture headache following spinal anaesthesia. This headache was of short duration and disappeared without treatment. Spinal anaesthesia caused more backache than general anaesthesia, otherwise the frequency of postoperative complaints was the same or lower. Ninety-six percent of the patients receiving spinal anaesthesia would prefer the same anaesthetic for a similar procedure in the future.