Clinical and Functional Outcomes of Platelet-Rich Plasma Injection and Corticosteroid Injection in Patients With De Quervain's Tenosynovitis: A Comparative Retrospective Study.

Background and aim De Quervain's tenosynovitis (DQST) is a prevalent condition involving tendon inflammation in the wrist. This study compares the clinical and functional outcomes between patients receiving platelet-rich plasma (PRP) injections and those receiving corticosteroid injections for DQST. Methods A retrospective study conducted at Sri Devaraj Urs Academy of Higher Education and Research, Kolar, India, included 58 patients with DQST, divided into Group A (PRP injection) and Group B (corticosteroid injection). Assessments were conducted using the Visual Analogue Scale (VAS), the Disabilities of the Arm, Shoulder, and Hand (DASH) score, and the Modified Mayo Wrist Score (MMWS) at baseline, one month, three months, and six months. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 22.0 (Released 2013; IBM Corp., Armonk, NY, USA), with significance set at p < 0.05. Results Both treatment groups demonstrated a reduction in VAS scores over time. Significant improvements were observed at one month (p = 0.007) and six months (p = 0.004) post-injection. Baseline (p = 0.336) and three-month (p = 0.829) VAS scores showed no significant differences. Similarly, DASH scores were not significantly different at any measured time points: baseline (p = 0.331), one month (p = 0.592), three months (p = 0.707), and six months (p = 0.314). MMWS scores also showed no significant differences at baseline (p = 0.123), one month (p = 0.101), three months (p = 0.422), and six months (p = 0.956). Independent sample t-tests highlighted significant VAS score improvements at one month (t = 2.813, p = 0.007) and six months (t = -3.009, p = 0.004), but DASH and MMWS scores showed no significant differences at any time points. Chi-square tests indicated no significant associations between the groups at one-month, three-month, and six-month follow-ups. Conclusion Both PRP and corticosteroid injections effectively alleviate pain in DQST patients, as evidenced by significant VAS score improvements. However, functional outcomes measured by DASH and MMWS scores did not significantly differ between the treatments. These results suggest that while both treatments are effective for pain management, their short-term impact on functional improvement may be similar. To investigate long-term functional results, more research with bigger sample sizes and longer follow-up periods is required.

Effectiveness of Surgical Drains in Obese Patients Undergoing Lumbar Discectomy.

Background The placement of postoperative drains after spine surgery is a contentious issue, and its application has changed over time. Obesity itself is an independent risk factor for postoperative complications. Hematomas in the surgical wound are a complication that may necessitate revision surgery. Orthopaedic surgeons frequently use closed drainage in orthopaedic surgery to prevent the formation of a hematoma. It remains unclear whether drains reduce postoperative complications and improve clinical outcomes, especially in obese patients who are already at risk of such complications. Objectives To assess the incidence of surgical site infections (SSI) after lumbar discectomy in obese and morbidly obese patients with or without postoperative wound drainage and compare functional outcomes between both groups. Methodology A hospital-based retrospective study was conducted among 84 patients with obesity who underwent single-level lumbar discectomy at R. L. Jalappa Hospital and Research Centre, Kolar, India from May 2022 to April 2023. Drains were used for patients in Group A and avoided for patients in Group B. Results Postoperative C-reactive protein (CRP) levels in the non-drainage group were much higher than in the drainage group and were statistically significant. There was a statistically significant association found between body mass index (BMI) and postoperative SSI. In Group A, only three patients had SSI while in Group B, eight patients suffered from SSI. Conclusion Closed suction drains were shown to have a positive impact in reducing SSI in patients with obesity. Drain tip culture may be beneficial in detecting SSI at the earliest. Hence, we believe that closed suction drainage can be considered as a standard protocol in obese patients.

Comparing the Efficacy of Intra-articular Platelet-Rich Plasma and Corticosteroid Injections in the Management of Frozen Shoulder: A Randomized Controlled Trial.

Introduction Periarthritis of the shoulder, or frozen shoulder (FS), is a common, painful, and disabling condition with varied treatment strategies. Intra-articular (IA) corticosteroid (CS) injections are a popular treatment option, but their efficacy is often temporary. Platelet-rich plasma (PRP) has emerged as an alternative therapy for adhesive capsulitis, but the literature on its effectiveness is limited. This study aimed to compare the efficacy of IA PRP and CS injections in managing FS. Methods In this prospective, randomized study, 68 patients who met the inclusion criteria were enrolled and randomized using a computer-generated table into two groups: Group 1 (IA PRP) received 4 ml PRP, and Group 2 (IA CS) received 2 ml (80 mg) of methylprednisolone acetate mixed with 2 ml normal saline (for a total of 4 ml) as a CS injection in the IA area of the shoulder. Outcome measures included pain; shoulder range of motion (ROM); the condensed version of the disabling conditions of the arm, shoulder, and hand (QuickDASH) score; and the shoulder pain and disability index (SPADI) score. Participants were monitored via follow-up for 24 weeks, with pain and function assessed at each evaluation using the visual analog scale (VAS) score, the SPADI score, and the QuickDASH score. Results The IA PRP injections demonstrated better long-term outcomes than the IA CS injections, significantly improving pain, shoulder ROM, and daily activity performance. After 24 weeks, the mean VAS score in the PRP and methylprednisolone acetate groups was 1.00 (1.0 to 1.0) and 2.00 (2.0 to 2.0), respectively (P≤0.001). The mean QuickDASH score was 41.83 ± 6.33 in the PRP group and 48.76 ± 5.08 in the methylprednisolone acetate group (P≤0.001). The mean SPADI score was 53.32 ± 7.49 in the PRP group and 59.24 ± 5.80 in the methylprednisolone acetate group (P≤0.001), indicating a significant improvement in the PRP group's pain and disability scores after 24 weeks. The rate of complications was similar between the two groups. Conclusions Our findings suggest that IA PRP injections provide better long-term results than IA CS injections for managing FS. Platelet-rich plasma can be used as a treatment modality for better outcomes, particularly when the patient is contraindicated or refuses CS treatment. Further research is needed to evaluate the efficacy of these treatment modalities at different stages of FS and explore the potential benefits of ultrasound-guided injections.

Functional Outcome of Pediatric Subtrochanteric Fractures Treated With a Titanium Elastic Nailing System (TENS) Versus Plating.

Introduction Uncertainty exists regarding the ideal course of therapy for subtrochanteric fractures in children of intermediate age. These fractures are challenging to treat, with scarce literature-based evidence to support a definitive implant. The ideal course of treatment should consider the patient's weight, age, femoral canal size, associated injuries, fracture stability, and surgeon's experience. A subtrochanteric femoral fracture in a child between the age of 5-12 is difficult to treat. For these patients, there is debate concerning the optimal internal fixation, hence this study was conducted to try and determine the superior mode of treatment for these fractures. The objective of this study is to compare functional outcomes of subtrochanteric fractures in the paediatric age group operated on with titanium elastic nail and plate fixation and the complications associated with both treatment modalities. Materials and methods This is a retrospective observational study of 40 cases that were admitted and operated on in the hospital of the current study from May 2007 to November 2021. Twenty patients underwent titanium elastic nailing system (TENS) nailing and the other 20 patients underwent plating for subtrochanteric fractures. The surgeries were conducted at our institute and patients were followed up at one-, three-, and six-month intervals. The final functional results were calculated with the help of the Flynn scoring system.  Results Out of 40 patients involved in the present study, 17 were female while 23 were male. Twenty patients received treatment with titanium elastic nails, and the remaining twenty received plating. The majority of the patients were males around 9.6 years of age on average in the plating group and 8.9 years in the nailing group. In comparison to 75% of participants in the plating group, 40% of patients who received nailing showed excellent results. Results were satisfactory for five patients who received titanium elastic nails and one who received plating. The only poor outcomes were noticed in six people (30%) in TENS and three people (15%) in the plating group who went through unplanned surgery for complications. In comparison to the plating group, the overall rate of complication was much greater in the TENS group. Conclusion We would like to conclude our study that, in accordance with Flynn's score, both elastic nailing and plating stabilization can produce positive functional outcomes. Both groups have a similar percentage of excellent and good results. We also conclude that the overall complication rate is slightly higher for patients treated with TENS when compared to plating for subtrochanteric fractures.

Evaluation of the Functional Outcome of Both Bone Forearm Fractures in the Pediatric Population With the Titanium Elastic Nailing System in a Tertiary Care Center.

Background Forearm fractures are one of the most common injuries in the pediatric population. Diaphyseal fractures of the forearm, in particular, are among the most common injuries treated in the pediatric population. The incidence of both bone forearm fractures has increased in the past decade. Methodology This is a hospital-based retrospective study conducted from June 2020 to December 2022 at R. L. Jalappa Hospital and Research Centre in the orthopedics department after obtaining clearance from the institutional ethics committee. Once inclusion and exclusion criteria are met, participants with both bone forearm fractures were treated with the Titanium Elastic Nailing System (TENS). Data were entered and analyzed using IBM Corp. Released 2011, IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp, Armonk, NY, USA). Results Thirty patients were included in the study, with a mean age of 8.80 years. The majority were boys constituting 67% and girls constituting 33%. A road traffic accident was the mechanism of injury in the majority of patients (40%). The distal one-third forearm was the most common site fractured (63%). The mean flexion (active) at the elbow improved from 110°at at four weeks to 142° at 24 weeks. A restriction of about 23° in elbow extension at four weeks normalized to 0° at 24 weeks. The range of palmar flexion improved from 44° at four weeks to 68° at 24 weeks. The range of wrist dorsiflexion improved significantly over time from 46° at four weeks to 86° at 24 weeks. Complications such as delayed union and skin irritation were noted in two participants (6%). Conclusions Both bone forearm fractures treated with TENS have shown good results in terms of bony union and functional outcomes with the least complications.

Comparison of Functional Outcome of Single Versus Multiple Intra-articular Platelet-Rich Plasma Injection for Early Osteoarthritis Knee.

Background Osteoarthritis (OA) is a leading cause of pain and disability and has a negative impact on patients' quality of life. Platelet-rich plasma (PRP) has emerged as a promising treatment for various orthopaedic conditions, such as tendinopathies, nonunion, and arthritis of the knee. We sought to determine whether a single intra-articular platelet-rich plasma injection has better functional and pain outcomes when compared with multiple (two) articular platelet-rich plasma injections given in the early stages of OA of the knee, measured using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the visual analogue scale for pain (VAS) at the sixth week, third month, and sixth month. Materials and methods The prospective observational study was conducted among patients diagnosed with early OA who presented to the Department of Orthopaedics, R. L. Jalappa Hospital and Research Centre, Kolar, Karnataka, India, between January 2020 and June 2021. A total of 64 patients were divided into: (i) S-PRP group (34 patients), which received a single PRP injection, and (ii) M-PRP group (30 patients), which received multiple (two) PRP injections, one on presentation and the second in the thirdmonth. VAS and WOMAC scores to assess functional outcomes were used at the first visit before the intervention and at the sixth week, third month, and sixth month. Results The average age of the patients was 55.26 years in the S-PRP group and 51.13 years in the M-PRP group. Both genders were equal among study participants in the M-PRP group, but 79.4% were females in the S-PRP group. In the S-PRP group, 74% had grade II OA and 26% had grade I OA. In the M-PRP group, 60% had grade II OA and the remaining 40% had grade I OA. The decreasing trend of pain and functional limitation, which was measured by VAS and WOMAC, respectively, was observed in both groups at pre-injection, sixth week, third month, and sixth month. These differences were statistically significant. The mean difference in VAS score between the pre-injection period and at six months was 4 in the S-PRP group, whereas it was 5.77 in the M-PRP group, and this was statistically significant (p-value = 0.001). Thus, multiple PRP injections have a greater response to pain reduction when compared to single PRP injections, according to the VAS score. According to the WOMAC score, there is no statistically significant difference in the treatment response with PRP injection between the S-PRP and M-PRP groups at any follow-up period. Conclusion According to the VAS score, single PRP injections have a lower pain score than multiple PRP injections until three months of follow-up, while at six months, single PRP injections have no better effect than multiple PRP injections. But multiple PRP injections have a higher reduction in the intensity of pain when compared to single PRP injections during the follow-up period. According to the WOMAC score, there is no statistically significant difference in the treatment response with PRP injection between S-PRP and M-PRP groups.

Surgical Management of Flexion Type Supracondylar Humeral Fracture With Ulnar Nerve Injury - A Report of a Rare Case.

Supracondylar humerus fractures in children account for up to two-thirds of pediatric elbow injuries that require hospitalization. Supra-condylar fractures usually occur due to falls from height, from sports, or through acts of leisure. The estimation of their incidence is about 177.3 per 100000. Here, we report a successfully managed case of flexion-type supra-condylar fracture of the humerus with ulnar nerve injury without any complications.

The Functional and Radiological Outcome of Hoffa's Fracture Treated With Cannulated Cancellous Screws.

INTRODUCTION: Distal femur AO type 33 B fractures consist of partial articular fractures subdivided into three types namely sagittal lateral condyle fracture, medial condyle fracture, and coronal split fracture. Coronal plane fractures of the distal femur are less frequent compared to sagittal plane fractures and are known as Hoffa fractures. The mechanism of injury is usually a direct anteroposterior force to the flexed and abducted knee for lateral condylar fractures and a direct impact on the medial side of the knee in flexion for a medial condylar fracture. Various approaches like lateral parapatellar for lateral condylar Hoffa's fixation, with or without posterior approach for open reduction of Hoffa's fracture with screw or buttress plate fixation, medial parapatellar approach for medial condylar Hoffa's fracture screw fixation are used. MATERIALS AND METHODS: This study was conducted at R L Jalappa Hospital and Research Center attached to Sri Devaraj Urs Medical College, Kolar, India, from June 2017 to May 2020 with 17 patients as a sample size. RESULTS: Seventeen patients with Hoffa's fracture were treated with cannulated cancellous screws with lag effect including 12 males and five females with a mean age of 31.1 years. The range of motion ranged from 120 to 135 degrees of flexion with a mean of 125.2 degrees. Three patients had extensor lag ranging from 5 to 10 degrees with an average of 6.3 degrees. Neer scores were excellent in 11, good in four, and fair in two patients. The average fracture union time for the lateral condyle was 16.4 months and for the medial condyle, it was 16.7 months. CONCLUSION: Restoration of articular anatomy and its congruence is of paramount importance for better surgical outcomes. Closed or open reduction and stable fixation with anteroposterior cannulated cancellous screws are essential. A good post-operative rehabilitation program is required for better outcomes.

Functional Outcome of Platelet-Rich Plasma (PRP) Intra-lesional Injection for Tennis Elbow - A Prospective Cohort Study.

Introduction Platelet-Rich Plasma (PRP) is an autologous human plasma preparation with a higher platelet concentration. Injection of PRP were, found to be effective in treating tendinopathy and arthritis. A few studies only focused in using PRP injection in patients with tennis elbow. This study was conducted to access the functional outcome of PRP injection in tennis elbow patients. Methodology A prospective study was done from June 2020 to June 2021, at R. L. Jalappa Hospital, Kolar, India among 80 individuals diagnosed with tennis elbow. All individuals aged between 18 to 65 years of either gender and the pain symptoms not subsided with oral analgesics or physiotherapy were included in this study. We analysed all the patients with a MAYO elbow performance score and Visual Analogue Pain Scale (VAS) during the follow-up period. Results In total, 80 individuals participated in our study, of which the mean age of the participants was 45.54. There is statistical significance in the difference of means of pain score obtained using both VAS and MAYO score at 12 weeks and 24 weeks. There is high significant positive correlation of age with the pain scores at 12th week and 24th week after the procedure. Conclusion In tennis elbow patients, PRP injection shows an effective reduction in pain according to VAS and MAYO score and especially, younger age patients have shown more benefit in terms of pain reduction with PRP treatment.

Safe Surgical Dislocation and Open Reduction, Internal Fixation with Herbert Screw for Pipkin's Fracture Head of Femur in an Obese Patient: An Interesting Case Report.

Head of femur fractures are relatively rare and tend to be associated with dislocations of the hip and fractures of the acetabulum. Other parts of the femur, namely the neck is also often involved. Only two cases per million are reported on a yearly basis which poses significance due to its extreme rarity. Here, we present a 30-year-old obese male patient with Pipkin's fracture who was treated successfully by us without any major complications.

Femur Shaft Fracture in Newborns: A Report of Two Cases.

Birth injuries caused by trauma during the childbirth process are very rare. They are a cause of significant neonatal morbidity despite improved obstetric and perinatal care, particularly in developing countries. Our current research, consisting of two newborns with a femur fracture, aims to shed light on their treatment strategy.

Bilateral Clavicle Fractures - A Rare Injury.

Both surgical or nonsurgical management of bilateral clavicle fractures have advantages and disadvantages. Hence a patient must be advised for shared decision making. Our patient was a painter by occupation with a left-sided dominant hand. Considering his job and financial constraints, we fixed his left clavicle fracture surgically and treated his right-sided clavicle fracture conservatively. We suggest based on our report concerning this rare injury, is that not all fractures need to be fixed surgically. Patient needs and other factors should be taken into consideration before taking the patient for surgical management.

Unusual Good Functional Outcome After Surgical Management of Maluniting Schatzker Type II Fracture.

Tibial plateau fractures account for approximately 1% of all fractures. The reported incidence is about 10.3 per 100,000. Isolated tibial plateau fracture with articular step-off of 4 mm or less can be optimally treated with conservative management. An unstable joint requires further workup to determine whether fracture fragment movement or ligament pathology is the underlying cause of instability. We report the management of a case of delayed presentation of the proximal tibia with the neck of fibula fracture with foot drop.