International Journal of Research in Orthopaedics | January-February 2019 | Vol 5 | Issue 1 Page 140 International Journal of Research in Orthopaedics Acharya HP et al. Int J Res Orthop. 2019 Jan;5(1):140-144 http://www.ijoro.org Original Research Article Trousseau’s sign in orthopedic: a rare sequelae of inadequate postoperative pain management Hriday P. Acharya*, Zulfikar M. Patel, Nirav K. Mungalpara, Meet S. Mehta INTRODUCTION Pain management in Orthopedic is very crucial matter to handle which is many times not managed properly and that leads to various medical complications to the patients. Pain perception is depends on age, sex and psychological status of the patients. 1 Inadequately managed post operative pain to the patients lead to physiological changes that may be present as Respiratory Alkalosis. 2 We are here presenting an interesting case series that represents such a rare complication of inadequately managed post operative pain in orthopedic ward. Trousseau sign of latent tetany is a medical sign observed in patients with low calcium. The causes of the same are acute hyperventilation, psychogenic hyperventilation, magnesium deficiency, thrombophlebitis, hypo- parathyroidism, malignant neoplasm of pancreas, barter disease and Gitelman diseases. The patient typically develops flexion in wrist and MCP joint, extension of IP joint and adduction of thumbs and fingers. A lot has been described about this sign in various literature, however none of the literatures describe the development of Trousseau sign in post operative patients and its importance as inadequately managed post operative pain in the field of orthopedics. Here we find an association of this sign in post operative patients with lower limb fractures. This is the first and one of a kind case series ABSTRACT Background: Pain management in orthopedic is very crucial matter to handle, which is many a times not managed properly and that leads to various medical complications to the patients. Trousseau sign of latent tetany is a medical sign observed in patients with low calcium. This is the first and one of a kind case series describing the development and pathogenesis of Trousseau sign in orthopedics. Methods: This is a case series of 5 patients with lower limb fractures who underwent surgery. All these patients developed Trousseau's sign in immediate postoperative period. All the patients were investigated and were diagnosed with respiratory alkalosis. They were managed with closed bag ventilation which relieved the symptoms. Results: Here we put forward a direct physiological and psychological relation between a low pain threshold and associated hyperventilation with lead to development of Trousseau's sign in our patients. So, next time in postoperative round, if we see patient hyperventilating and complaining about fixed hand’s position, do not start calcium gluconate drip immediately, it may be due to respiratory alkalosis, then closed bag ventilation would be suffice. Conclusions: Trousseau’s sign seen postoperatively in Orthopedics may be commonly due to inadequate pain management rather than altered calcium metabolism. Keywords: Pain management, Fractures, Trousseau's sign, Calcium metabolism, Respiratory alkalosis Department of Orthopaedics, B J Medical College and Civil Hospital, Asarwa, Ahmedabad, Gujarat, India Received: 01 October 2018 Accepted: 23 November 2018 Accepted: 26 November 2018 *Correspondence: Dr. Hriday P. Acharya, E-mail: hridayacharya21@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20185336