We report a study which shows that the traditional transthecal injection technique provides poor correctness but stable anesthetic effects. We investigated whether a small quantity of anesthetic is effective or leakage into the subcutaneous tissue is effective. Accurate transthecal injection technique was necessary to examine how the technique affects transthecal digital block. An injection study using contrast medium and lidocaine was performed on the middle fingers of healthy volunteers. Our new transthecal injection technique involved inserting a needle at the palmophalangeal crease, penetrated the flexor tendon to the proximal phalanx, without withdrawing the needle during injection. We believe that the success rate of traditional transthecal injection technique is very low due to the use of loss of resistance by withdrawing the needle. This technique allows comparison of anesthetic effects between the transthecal digital block and subucutaneous digital block.
We studied femoral head perfusion in 21 femoral neck fractures using dynamic MR Imaging (MRI) between November 2001 and July 2002. MRI patterns divided into four groups when the results between the fractured side and unaffected side were compared. Femoral head perfusion at the fractured side was normal in Type A, about half in Type B, and absent in Type C. When perfusion at both the fractured side and unaffected side was absent, Exceptional Type was suspected. The Garden II group consisted of one Type B. The Garden I group consisted of one Type A, six Type B, one Type C, and two Exceptional Type. The Garden III group consisted of two Type B and one Type C, and the Garden II group consisted of six Type C and one Exceptional Type. Post operations of by internal fixation confirmed the incidence of aseptic necrosis using MRI.