Dual-NIR wavelength (pulsed 810 nm and superpulsed 904 nm lasers) photobiomodulation therapy synergistically augments full-thickness burn wound healing: A non-invasive approach.

A thermal burn is the most frequent, distressing form of trauma. Globally, there is a critical necessity to explore novel therapeutic strategies for burn wound care. Combination therapy has marked therapeutic efficacy in positively regulating various phases of wound repair. Photobiomodulation (PBM) is a biophysical, non-thermal therapeutic healing modality to treat chronic non-healing wounds. It hypothesized that PBM using combined NIR wavelengths may absorb through different cellular photoacceptors with varying degrees of tissue penetration, which can potentially regulate the pace of healing. Therefore, the current study investigates the efficacy of dual-NIR wavelength treatment employing pulsed 810 nm and superpulsed 904 nm lasers PBM on transdermal burn repair in rats and unveils the associated molecular mechanistic insights. Rats were randomized into five groups: uninjured skin, burn control (sham-exposed), standalone treatment with pulsed 810 nm laser, superpulsed 904 nm laser, and dual combination groups. The present findings revealed that PBM with dual-NIR wavelength synergistically augmented burn wound healing compared to control and standalone treatments. The efficacy of combined treatment was exhibited by significantly enhanced wound area contraction (α-smooth muscle actin), proliferation (PCNA, cytokeratin-14, TGF-ß2), angiogenesis (HIF-1α, CD31), ECM accumulation/ organization (collagen type 3, fibronectin), dermal hydration (AQP3), calcium homeostasis (TRPV3, calmodulin), and bioenergetics activation (CCO, AMPK-α, ATP). Collectively, PBM with dual-NIR wavelength (pulsed/ superpulsed-mode) treatment accelerates full-thickness burn wound healing, which could be used as a non-invasive translational approach in clinical significance in conjunction with existing burn wound care management.

Effect of combination of photobiomodulation 904 nm superpulsed laser therapy and Hippophae rhamnoides L. on third-degree burn wound healing.

BACKGROUND: Burn is a traumatic injury and aesthetic scarless repair poses a great challenge in area of cosmetic dermatology. Focus on multimode therapeutic strategies to promote healing of burns by regulating various stages of healing is warranted. Photobiomodulation therapy (PBMT), a non-invasive modality grabs the attention to repair impaired wounds. Seabuckthorn extract (SBTL-ALE) is known to possess antioxidant, anti-inflammation, and tissue-repair abilities. Current study aims to assess the effect of combination treatment of PBM 904 nm superpulsed laser and SBTL-ALE (2.5%) on repair of third-degree burn in rats. METHODS: Rats were randomized into five groups: uninjured, control, SBTL-ALE, 904 nm PBMT, and combination. A transdermal burn wound was induced on the dorsal side of rats of all groups except the uninjured group and respective treatment was applied for 7 days postwounding. RESULTS: Dual treatment increased wound area contraction compared to control and either treatment alone. Immunohistochemical analyses exhibited increased angiogenesis, dermal hydration, collagen synthesis, and maintained redox homeostasis as evidenced by enhanced expression (p < 0.05) of CD31, aquaporin3, collagen type 3, Nrf2, and HO1 in combination group compared with control. Conversely, pro-inflammatory and oxidative stress markers exhibited reduced (p < 0.05) TNF-α, IL-6, IL-1ß, NOS-2, ROS levels, and increased catalase activity in combined treatment. Furthermore, energy metabolizing enzymes viz. citrate synthase, CCO, and ATP contents were substantially (p < 0.05) increased, and LDH activity was reduced in the combination group. CONCLUSIONS: Dual treatment (PBMT + SBTL-ALE) prominently accelerates third-degree burn wound healing in rats, which could pave the path for multimode therapeutic strategies for the management of burns and dermal cosmetic care.

Outcome of Simultaneous Arthroscopic Anterior Cruciate Ligament and Posterior Cruciate Ligament Reconstruction With Hamstring Tendon Autograft: A Multicenter Prospective Study.

BACKGROUND: Multiligamentous injuries of knee are a complex problem in orthopaedics. Combined ACL-PCL injuries are uncommon, usually associated with knee dislocations. Extremity vascular status is essential because of possible arterio-venous compromise. These complex injuries require a systematic evaluation and treatment. Single setting simultaneous arthroscopic ACL and PCL reconstruction or a staged approach can be adopted to treat these cases. OBJECTIVES: To evaluate functional outcome of simultaneous arthroscopic ACL and PCL reconstruction with hamstring tendon autograft in multiligamentous knee injuries. PATIENTS AND METHODS: This prospective study was performed on 20 patients with combined ACL-PCL injuries who underwent simultaneous arthroscopic ACL-PCL reconstruction with hamstring tendon. Evaluation of functional outcome was by IKDC and Lysholm-Tegner scores. RESULTS: In 20 patients, mean age 34 years, return to full-time work and to full sports was 8 weeks and 6.2 months respectively. All patients had full range of motion except 2 patients with < 5 degrees flexion loss; 90% had negative Lachmann test; 95% had negative pivot shift and 10% patients had mild posterior drawer at 90 degrees (1+) at final follow up. Mean IKDC score was 90 (range 81 - 94); mean Tegner activity score was 7 and mean Lysholm knee score was 89. 85% returned to preinjury activity level and a 90% satisfaction rate. CONCLUSIONS: Simultaneous arthroscopic ACL and PCL reconstructions using hamstring tendon for combined ACL and PCL injuries is a clinically effective, safe, time saving and cost-effective procedure with better patient compliance and reproducible for a timely return of motion, strength, and function with favorable outcome.

Bilateral ACL Reconstructions with Hamstring Autografts.

Bilateral anterior cruciate ligament (ACL) injuries are rare with incidence between 2 and 4%, and presently no definitive guidelines for proper management exist. Ideal treatment protocol remains controversial between a single-stage and two-stage bilateral ACL reconstruction. The purpose of this study is to evaluate the outcome of single-stage bilateral ACL reconstruction with hamstring tendon autografts in bilateral ACL injuries. A prospective study was undertaken including a total of 14 consecutive patients with bilateral ACL deficient knee who underwent single-stage bilateral ACL reconstruction with hamstring tendon autograft with a mean follow-up duration of 28 months (24-38 months). Functional outcomes were evaluated by range of movements, International Knee Documentation Committee (IKDC), Lysholm and Tegner activity score, and stability tests. The mean age was 30 years (range 18-42 years). Average duration of rehabilitation was 8 weeks. Time to return to full-time work and full sports was 5.6 weeks and 6.2 months, respectively. Clinical examination demonstrated full range of motion; a total of 12 patients (86%) had a negative Lachman test and 13 patients (93%) had a negative pivot shift at the final follow-ups. The mean IKDC evaluation score was 89 points, the mean Tegner activity score was 7 points, and the mean Lysholm knee score was 91 points. A total of 12 patients (86%) returned to their preinjury level of activity and an overall greater than 90% satisfaction rate was achieved. Single-stage bilateral ACL reconstruction using hamstring autografts is clinically safe, effective, and cost-effective with better patient compliance and with comparable functional outcome as opposed to two-stage ACL reconstructions.

Fragility Hip Fractures in Elderly Patients in Bhubaneswar, India (2012-2014): A Prospective Multicenter Study of 1031 Elderly Patients.

Elderly patients with hip fracture constitute Single Largest Group of Emergency Orthopaedics Admissions. In 2050, 6.26 million hip fractures worldwide, approximately 50%, will occur in Asia. Only small number of reports on incidence of hip fractures in the Asian population exist. India lacks data registry for fragility hip fractures, therefore, the magnitude and standard of patient care are not known. A prospective multicenter study was conducted from January 2012 to April 2014 to describe population-based longitudinal trends, namely, age-specific incidence, fracture type, timing of presentation, kilometers traveled, timing of surgery, hospital stay, man hours lost, pressure ulcers, weight bearing, 30-day return, 3-month mortality, and so on, of fragility hip fractures. A total of 1031 patients were included with 59.7% females and 40.3% of male patients, with a female-male ratio of 1.5:1. Commonest mode: Falls 45%. 56.4% IT fractures. 66.2%patients operated, Operative/Conservative Ratio of 2.8:1. Patients travel a mean distance of 86.4 kilometers for quality treatment. Of the patients, 85.9 % presented late due to ignorance and misguiding quack practice. Incidence of delayed surgery was 69.3%. Persistent electrolytes imbalance and hyperglycemia normalized in 81.2% by second or third postoperative day. The man hours lost was 157.85 hours/person. Medical complications was more (90%) in patients who had delays in surgeries and presentation. Mortality rate was 6.2 %. Patients travel long for quality treatment, most of them are misguided, present late with significant complications and sufferings, and their pockets half drained depriving them off best treatment. Early presentation and operation have better prognosis and rehabilitation, facilitates early return to work, and independence. Increased pressure sores, infections, hospital stay, treatment cost, depression, and mortality are directly related to delays in surgeries and presentation. Estimated losses according to lost man hours may go up to 10 million dollars.

Intra-articular Adjuvant Analgesics following Knee Arthroscopy: Comparison between Single and Double Dose Dexmedetomidine and Ropivacaine A Multicenter Prospective Double-blind Trial.

OBJECTIVE: Knee arthroscopy is a commonly performed orthopedic procedure. Post-operatively, adequate pain relief reduces the surgical stress response and patient's morbidity and facilitates rehabilitation. The analgesic effect of dexmedetomidine (2 µg/kg body weight) as an adjunct to ropivacaine in knee arthroscopic knee procedures was studied to determine whether this would achieve longer post-operative analgesia and whether the study dosage of dexmedetomidine was safe and free of adverse effects. PATIENTS AND METHODS: In a multicenter prospective double blind trial of sixty patients undergoing knee arthroscopic procedures, patients were randomly assigned to three groups: Group R, receiving intra-articular ropivacaine (20 mL); Group D1 (18 mL ropivacaine, dexmedetomidine 1 µg/kg body weight); and Group D2 (18 mL ropivacaine, dexmedetomidine 2 µg/kg). RESULTS: Group D2 had significantly lower pain scores for the first 12 postoperative hours than Group D1 and Group R. Time to first analgesic requirement was longest in Group D2 (757.30 ± 207.68 min), followed by Group D1 (433.2 ± 54.3 min) and Group R (311.80 ± 61.56 min); these differences were significant (P < 0.05). Total analgesic requirement was significantly lower in Group D2 (82.50 ± 48.05 mg; P < 0.05). Intensity of pain was significantly less in Group D2 in the third (P < 0.01) and sixth hours (P < 0.05). CONCLUSION: Intra-articular dexmedetomidine (2 µg/kg) has superior analgesic efficacy, delayed the first postoperative requirement for analgesia and decreasing the need for postoperative analgesics with no major adverse effects.

Thrombotic popliteal block following simultaneous bi-cruciate single-stage arthroscopic reconstruction in a neglected multiligamentous knee injury in a smoker.

We report a case of neglected multiligamentous injury that developed a complete thrombotic popliteal artery block following arthroscopic surgery. A 56-year-old man, a farmer, presented with an 8-month history of instability of the right knee. Examination revealed ipsilateral anterior (ACL)/posterior cruciate ligament (PCL) injuries. MRI and diagnostic arthroscopy confirmed complete ACL/PCL tear. Single-stage arthroscopic ACL/PCL reconstruction was performed. Postsurgery, the operated limb appeared swollen, firm and cold, without sensation or toe movement. Angiogram revealed complete thrombotic block of left popliteal artery. Fogarty's catheterism was performed and distal vascularity re-established. At 28 months, the patient was back at work with good functional outcome. We failed to examine the patient preoperatively in spite of his advanced age, history of beedi smoking and tobacco use, and presence of feeble vascular pulsations with thickened skin over leg and foot. Thus, in multiligamentous injuries, patient selection and thorough detailed clinical examination are the keys to successful arthroscopic procedures.

Neglected Pipkin's fracture dislocation with bilateral femoral shaft fractures: an unusual combination.

A hip fracture dislocation with contralateral femur fracture is a rare combination. We report a case of neglected posterior dislocation of hip with Pipkins-II femoral head and medial condylar fractures associated with a contralateral femoral shaft fracture. Right hip joint was approached via the Kocher-Langenbeck, following reduction, femoral head fragments were fixed with two 4-mm cannulated cancellous screws with open reduction internal fixation plating of ipsilateral femoral condylar fracture and closed reduction internal fixation nailing of left femur in the same sitting. Immediate postoperative X-rays were satisfactory. Postoperative period was uneventful. Over 7-year follow-up, patient is successfully performing his duties with X-rays bearing no signs of avascular necrosis (AVN) or hip arthritis. Thus, complex femoral fractures require a multidisciplinary approach for successful treatment. Early congruous reduction, anatomical fixation and early rehabilitation help in reducing the incidence of AVN and postoperative arthritis. Successful diagnosis of Pipkin's fracture dislocations requires use of CT, MRI and ultrasound in adjunct to X-rays.

Treatment analysis of paediatric femoral neck fractures: a prospective multicenter theraupetic study in Indian scenario.

PURPOSE: Paediatric femur neck fractures are exceedingly rare owing to dense bone surrounded by a strong periosteum; they account for 1 % of paediatric fractures and are usually associated with high energy trauma. METHODS: This was a prospective multicenter therapeutic study on pediatric femoral neck fractures from June 2004 to September 2013 at three centres in Odisha, India. Children with femoral neck fractures (Delbet type 2 and 3) who were operated and completed a minimum one-year follow-up were included. We divided the neck of femur (100 %) into four zones (25 % each), with zone I being highly unstable and zone IV being most stable. Implants for fixation, as suggested by pre-operative zone distribution, were used. RESULTS: Twenty-eight children were studied with mean two- to seven-year follow-up. In 23 children cancellous screws were used. In zone I Smooth Moore's pins that crossed the epiphysis were the implant of choice. Causes were avascular necrosis (14.2 %), nonunion (7.14 %) and one case of implant failure, while coxa vara was encountered in two instances. Functional results (Ratliff's criteria) were good in 82.1 %, fair in 7.1 % and poor in 10.7 % of patients; the mean IOWA hip scores were 96, 94 and 98, respectively. CONCLUSION: Early surgical intervention hastens recovery, rehabilitation and return to school and decreases the risk of developing avascular necrosis. We suggest Smooth Pins fixation in zones I and II (nearer to zone I) and cancellous screw fixation in zones II, III and IV. Decompression of hip joint by capsulotomy releases the tamponade effect and should be performed in all cases of paediatric femoral neck fractures.