Introduction: We hereby present results of controlled randomized trial of use of popliteal block for pain relief in ankle and hind foot surgery.

Materials and Methods: We have studied 47 patients over period of 9 months in 2007–08. Patients who needed ankle or hind foot procedure were selected for trial. Patients were explained about the trial and popliteal block along with leaflets at preoperative clinics. Patients were randomized on the day of surgery. A sealed envelop stating whether patient will go to block group (A) or no block group (B) was opened in the anaesthetic room before the patient was anaesthetized. Patients were evaluated for subjective pain scores at 30 min, 6hrs, 12 hrs and 24 hrs after surgery. Amount of anaelgesic required and time to first dose was documented. Popliteal blocks were given by one foot and ankle consultant and one trained fellow. The block was administered in lateral position at 0.8 mamp stimulus to detect the nerve. The data was compared statistically between group A and B.

Results: Average subjective pain scores in group A were reported to be 1.2 at 30 min, 1.23 at 6 hrs, 2.1 at 12 and 3 at 24 hrs. Where as in group B it was 1.2, 7.2, 8.1 and 4 at 30 min, 6 hrs, 12 hrs and 24 hrs respectively. There was statistically significant difference in pain scores at 6 and 12 hrs. There was no statistically significant difference in pain scores at 30 min and 24 hrs.

Conclusion: Popliteal block offers an effective way of pain relief in ankle and hind foot surgery. We believe that it may reduce amount of anaesthetic or anaelgesic drug requirement as well.

Background: Although bone marrow edema (BME) of the knee is a common phenomenon, physical tests to diagnose this condition have not been investigated thus far. We hypothesized that a mallet test would be useful as a diagnostic aid as well as a screening tool.

Methods: 70 patients (36 female, 34 male) were investigated in this controlled study. Group 1 consisted of patients with painful BME in the knee and group 2 of patients with a painful knee without BME. Pain provoked by a reflex mallet was assessed for each quadrant on a visual analog scale (VAS).

Results: The VAS score was 3.7 (±2.1 cm) for quadrants affected by BME (group 1), 1.59 (±1.44) in nonaffected quadrants of the knee affected by BME (group 1) and, 0.85 (±0.85) in painful knees without BME (group 2). Pain on the tapping test was significantly correlated with the presence of BME in the affected knee (p< 0.0001) as well as the affected quadrant (p< 0.0001 for the medial femoral condyle and the medial femoral plateau). Implicating a threshold value of VAS 2.0 for a tapping test to be positive in the distinction of BME affected quadrants of group 1 and all quadrants of group 2 sensitivitiy was 90.4%, specitivity 83.7%, positive predictive value 73.4% and negative predictive value 94.6%.

Conclusion: The tapping test is a good screening instrument to diagnose BME in the knee.

Introduction: Bone marrow edema syndrome (BMES) of the femoral head in pregnant women is a rarely seen disease associated with disabling pain in the hip, beginning in the second or third trimester and persisting after parturition.

Materials and Methods: We treated 4 postpartum women (6 hips) presenting with femoral head BMES with infusions of the prostacycline analogue iloprost (20 μg for 5 days) followed by 3 weeks of partial weight-bearing.

Results: Symptoms regressed rapidly during and after therapy. After 4 weeks, all patients were asymptomatic with no limitations in ambulation. In the magnetic resonance imaging assessment, complete regression of BMES could be detected in three patients and minor residual BMES in the femoral neck was found in one patient (one hip) after 3 months. Pain did not recur in any patient at a mean follow-up of 31 months (range, 14 to 43 months).

Conclusion: The vasoactive drug iloprost has good analgesic potency in the treatment of postpartum women suffering from BMES and accelerates the natural benign course of the disease.

Introduction: Intra-articular migration of bone marrow edema syndrome (BMES) is a very unusual pattern of disease which has been previously described in only a few cases and may raise the suspicion of an aggressive disease.

Materials and Methods: We reviewed 8 patients (4 women, 4 men) with unilateral BMES located in the knee. The patients were aged 39 to 56 years (mean 50.2). In all the patients, bone marrow edema found in the primary magnetic resonance imaging (MRI) migrated within the same joint, i.e. from the medial to the lateral femoral condyle or to the neighboring bone. Conservative therapy including limited weight-bearing for a period of three weeks was provided for seven patients after initial detection of BMES and one patient underwent surgical core decompression twice.

Results: MRI showed complete restitution in 6 cases and small residual edema in one case. A final MRI control was not obtained in one painless patient. In one patient, avascular necrosis of the contralateral hip was evident after 16 months. Improvement of the MRI pattern was correlated with the clinical outcome in all patients. All patients became asymptomatic after a mean of 9 months (range, 6–11).

Conclusion: Intra-articular migrating BMES is a condition seen very rarely. The disease is self-limited so that conservative therapy can be recommended.

Introduction: Although bone marrow edema (BME) of the knee is a common phenomenon, physical tests to diagnose this condition have not been investigated thus far. We hypothesized that a mallet test would be useful as a diagnostic aid as well as a screening tool.

Methods: Seventy patients (36 women, 34 men) were investigated in this blinded controlled study. Group 1 consisted of patients with painful BME in the knee and group 2 of patients with a painful knee without BME. Pain provoked by a reflex mallet was assessed for each quadrant on a visual analog scale (VAS).

Results: The VAS score was 3.7 (±2.1 cm) for quadrants affected by BME (group 1), 1.59 (±1.44) in non-affected quadrants of the knee affected by BME (group 1) and, 0.85 (±0.85) in painful knees without BME (group 2). Pain on the tapping test was significantly correlated with the presence of BME in the affected knee (p< 0.0001) as well as the affected quadrant (p< 0.0001 for the medial femoral condyle and the medial femoral plateau).

Conclusion: The tapping test is a good screening instrument to diagnose BME in the knee.