role of intraarticular platelet rich plasma [PRP] injection in patients with internal knee derangements

Platelet Rich Plasma [PRP] is an emerging biotechnology which uses patient's own blood components to create healing effect to their own injured tissues. This study was carried out to evaluate the clinical effects, adverse reactions and patient satisfaction after intraarticular injection of platelet rich plasma in a small group of patients with internal derangements of knee at Combined Military Hospital, Panoaqil, Pakistan. In this single center, open study, 10 patients with internal derangements of knee fulfilling the inclusion criteria received two doses of 3 ml of platelet rich plasma as intraarticular knee injection at two weeks interval. All patients were evaluated at 0, 4 and 12 weeks after treatment using IKDC, TEGNER, KOOS and VAS. Adverse events and patient's satisfaction was recorded. There was significant improvement in all scores. Intraarticular PRP injection is safe and effective method in the conservative treatment of internal knee derangements

Quality of life assessment in chronic skin disorders

To assess the impact of disease on quality of life of dermatological patients by using dermatology life quality index [DLQI]. One hundred consecutive adult patients with any dermatological disease lasting more than six months were interviewed and filled DLQI questionnaire. DLQI is a broad, self-administered, dermatology specific questionnaire that measures the impact of skin diseases on health-related quality of life in patients. It covers six domains [symptoms, feelings, routine daily activities, sports activities, work and school, personal relationships, and treatment] during the preceding one week. In our study, both original English and validated Urdu versions of the instrument were used for patients in either language of ease. There were 58 males and 42 females. Mean age was 42 +/- 17 years. A total of 26 dermatological diseases were found in our patients. Chronic eczema was the commonest diagnosis in 29% of patients, followed by melasma in 11%. The duration of illness varied from 6 months to 25 years whereas mean duration was 10.48 +/- 5.9 years. DLQI score varied from 0-20, mean score was 10.02 +/- 4.09. Score was significantly associated with disease duration [p value 0.0001, student t test]. The difference in DLQI scores between sexes was not significant [p value 0.32, student t test]. Skin diseases, irrespective of the diagnosis, impair quality of life which is directly proportional to the duration of disease

Technique of syndesmotic screw insertion in weber type C ankle fractures

To find out impact of the position of the ankle during tightening of the syndesmotic screw used to fix syndesmotic disruption in bimalleolar Weber type C ankle fracture. A randomised controlled clinical trial. Orthopaedic Department at Combined Military Hospital Malir Karachi, from October 2002 to December 2005. We hypothesized that syndesmotic screw tightening with ankle in plantigrade position rather than 200 dorsiflexion would result in reduced range of dorsiflexion of the ankle joint postoperatively. Twenty-one consecutive young active patients with Weber type C bimalleolar ankle fractures having syndesmotic injuries treated with open reduction and internal fixation were randomly allocated to two groups. In group I [n=10] syndesmotic screw was inserted with ankle in 200 dorsiflexion and in group II [n=11] syndesmotic screw was inserted with ankle in plantigrade position. Patients were followed up for 12 months. Study end point was healing of the fracture. Subjective and objective assessment with Olerud-Molander Ankle [OMA] scores and bi-planar radiography was done. The range of ankle dorsiflexion postoperatively, hardware failure and need to remove the screw were the outcome measures. Comparing two groups using paired sample t-test, we did not find a statistically significant difference in postoperative range of ankle dorsiflexion between the two groups [p values > 0.05]. Differences between the two groups as regard the OMA scores, hardware failure and need to remove the screws were not significant either. Syndesmotic screw can be tightened with ankle in plantigrade or dorsiflexed positions without resulting in reduced range of ankle dorsiflexion postoperatively

Syndesmosis fixation in bimalleolar weber C ankle fractures; comparison of 3.5 and 4.5-mm screws

To study the influence of size of screws for syndesmosis fixation in bimalleolar Weber C ankle fracture. A prospective randomised controlled clinical trial. Orthopaedic Department at Combined Military Hospital Malir. From October 2002 to September 2005. 17 consecutive young active patients with Weber type C bimalleolar ankle fractures having syndesmotic injuries treated with open reduction and internal fixation were randomly allocated to two groups. In group I [n[1] = 9] 3.5mm small fragment and in group II [n[2]=8] 4.5mm large fragment AO cortical screws were used for syndesmotic fixation. All patients were followed up for 12 months. Fracture healing or loss of reduction of syndesmosis was taken as the study end point. Hardware loosening or breakage and need for hardware removal were the outcome measures. Subjective and objective assessment with Olerud-Molander Ankle [OMA] scores1, range of motion and radiographic criteria was done. Loss of reduction was not seen in any patient in both groups. Comparing two groups using paired sample t-test, there was no difference in screw loosening and breakage [p values > 0.05]. We did not find a statistically significant difference between range of motion [p = 1.08] and OMA score [p-value = 0.805]. Size of the syndesmotic screw does not appear to influence healing of syndesmotic injury. Screw loosening, which can result in reduced range of ankle motion postoperatively was more common in smaller screw group though the difference was not significant