Clinical studies investigating the role of mesenchymal stem cells in healing of fracture non-unions: a systematic review.

Objectives: To identify and evaluate the effectiveness of mesenchymal stem cells (MSCs) in augmenting healing in fracture non-unions. METHODS: A focused literature search was performed on the PubMed/MEDLINE index using the keywords: "non-union", "mesenchymal stem cells", "bone healing", "MSC", "stem cells", and their MeSH terms. The search was reiterated until the 10th of August 2022. Clinical studies were included that assessed the effect of MSCs on fracture non-unions. RESULTS: Thirteen human clinical trials, studying a total of 318 participants were identified and studied. MSCs with and without biological or synthetic scaffolds were found to be effective in healing of non-unions. CONCLUSIONS: MSCs has been demonstrated to have promising outcomes in the treatment of bone non-union and tissue engineering methods utilizing MSCs may well prove to be valuable in accelerating the process of bone union. However, clinical application of MSCs as a standard method in achieving union in fracture non-unions requires larger clinical trials with a standardised approach to analyzing outcomes.

Functional Outcome Of Proximal Humeral Fractures Treated With Philos Plate In Adults.

BACKGROUND: Proximal humeral fractures account for 4-5% of all fractures. Most fractures are minimally displaced and can be managed non-operatively in adults. Displaced and unstable fractures are difficult to manage and should be treated to achieve painless shoulder and full function. Our aim was to evaluate the functional outcome of proximal humerus fractures (Neers classification 2 part, 3 part and 4 part) treated with PHILOS (Proximal humeral internal locking system). METHODS: We retrospectively reviewed 22 patients who had proximal humerus fractures treated with PHILOS plate from Jan 2012 to June 2013 conducted at Orthopaedic Department Liaquat National Hospital. Clinical outcome was measured using DASH (disability of arm, shoulder and hand) Score System. Radiological union was assessed by serial X rays. RESULTS: Two patients were lost to follow up. Mean age was 40 years (20-70). Mean follow up was 6 months. 4 patients had two-part fracture, 10 patients had three-part and 6 patients had four-part fracture. Radiological union was achieved in average 8.31 weeks (±1.37SD). Average DASH score in young patients was 15.14 (±1.91SD) and in elderly was 31.66 (±4.08SD). One case of implant failure was noted. Better results in younger patients were achieved as compared to elderly proved by DASH score. CONCLUSIONS: Increase in number of fracture parts and delay in treatment did not affect the outcome. Our study concluded that this implant provides stable fixation in younger patients with good quality bone sufficient to allow mobilization.

Precontoured anatomical plates new era in the complex tibail plateau fractures fixation.

OBJECTIVE: Functional outcome of Intraarticular Tibial Plateau Fractures fixed with precontoured anatomical plates using Knee Society Score. METHODS: Observational study with retrospective review of collected data. Patient's demography, mechanism of injury, schatzker's classification includingtype IV, V and VI. All patients underwent screw and plate fixation using two incision technique with pre-contoured anatomical plates and intercondylar lag screws where indicated. Passive range of motion exercises started at 2 weeks. Postoperative knee pain, range of motion and stiffness were recorded at followup 3 and 4 months. Mean±SD were calculated for quantitative variables and qualitative variables were presented with frequency and percentages. The association of outcome (Knee Society Score) with gender, age and Schatzker's type was evaluated by applying Fisher's Exact test considering p-value <0.05 as significant. RESULTS: Twenty-five patients were included in study. 20 patients were available and 05 lost to follow up. 16 were males and 4 females out of 20 patients. Average age is 36.2±12.89 years. All patients sustained injuries after RTA. 5 patients had postoperative knee pain while remaining were pain free. Average flexion was 123.8 with (SD 8.88)range of 105 to 135 degree. Average extension was 3.15 with (SD 2.41) range of 0 to 8 degress. 4 patients developed stiffness of knee. 2 patients symptomatic implant. All fractures healed at follow up at 4 months. According to Knee Society score (SD 7.65) 14 cases scored as good, 4 cases scored fair and 2 cases scored poor. There was no association of knee score was found with gender (p=0.493) but significant association of knee score was found with age (p=0.007) and Schatzker's type (p=0.028). CONCLUSIONS: Tibial plateau fractures can be effectively treated by anatomical reduction and absolute fixation using pre-contoured anatomical plates. Functional outcome calculated by Knee Society score is better in young patients. With appropriate surgical techniques and early post-operative rehabilitation, good functional results can be achieved.

Knee dislocations and popliteal artery injury: A single centre experience from Karachi.

OBJECTIVE: To determine the association of popliteal artery injury with simple knee dislocations or knee fracture dislocations, and to evaluate the role of clinical assessment and colour Doppler ultrasound examination in diagnosing these injuries. METHODS: The prospective case series study was done at the Liaquat National Hospital, Karachi, and comprised patients with simple knee dislocations or knee fracture dislocations presenting between February 2013 and April 2014. All patients underwent clinical assessment including distal pulse examination and signs of vascular trauma. Following reduction of dislocation, repeat clinical examination and assessment of limb with colour Doppler ultrasound was carried out. RESULTS: Out of 9 patients in the study, 6(66.7%)had simple dislocations, while 3(33.3%) sustained fracture dislocations of the knee. Two (22%) patients sustained injury to the popliteal artery which was effectively managed via surgical treatment. Clinical examination of the affected extremities effortlessly revealed the 2(22%) vascular trauma cases. Doppler ultrasound was carried out in 8(89%) cases and it successfully excluded 7(78%) cases for vascular trauma and identified 1(11%) injury with reduced flow. This case underwent computed angiography scan and later surgery revealed popliteal artery trauma. Doppler ultrasound was not carried out in 1(11%) case which was a spontaneously relocated knee with hard signs of vascular injury. CONCLUSIONS: Popliteal artery injury can be a limb-threatening complication following trauma to the knee. Carefully performed clinical examination and colour Doppler ultrasound are effective tools for identification of such cases.