PRP IN THE TREATMENT OF TROCHANTERIC SYNDROME: A PILOT STUDY

ABSTRACT Objective: To compare the efficacy of platelet rich plasma (PRP) against corticosteroid on the treatment of trochanteric pain syndrome . Methods: From July 2011 to November 2012, eighteen patients (20 hips) with trochanter pain syndrome were randomized in two groups and treated with platelet rich plasma or triamcinolone infiltration guided by ultrasound. Pain and function were evaluated prior to the intervention and after 10, 30 and 60 days, through the Facial Expressions Scale for Pain and the Western Ontario McMaster and Harris Hip Score questionnaires. Inter-group analysis was performed by Student t-test and intragroup analysis by ANOVA, followed by Bonferroni post hoc test. Statistical significance was set at p <0.05 . Results: There was no difference between the groups. The triamcinolone group showed pain reduction (p=0.004) and improved function (p=0.036) through the Harris Hip Score questionnaire at 10, 30 and 60 days after treatment, when compared with the pre- intervention period. The platelet rich plasma group showed no statistical improvement in any of the variables . Conclusion: Up to 60 days, PRP infiltration has no influence on pain relief and function improvement in trochanteric syndrome treatment. Level of Evidence II, Prospective Comparative Study.

What is the real angle of deviation of metacarpal neck fractures on oblique views? a radiographic study / Qual é o ângulo real do desvio da fratura do colo do metacarpo nas incidências oblíquas? estudo radiográfico

OBJECTIVE: The aim of this study was to establish an indirect, easy-to-use, predictable and safe means of obtaining the true degree of displacement of fractures of the neck of the fifth metacarpal bone, through oblique radiographic views. METHODS: An anatomical specimen from the fifth human metacarpal was dissected and subjected to ostectomy in the neck region. A 1-mm Kirschner wire was fixed to the base of the fifth metacarpal bone, perpendicular to the longitudinal axis of the bone and parallel to the ground. Another six Kirschner wires of the same diameter were bent over and attached to the ostectomized bone to simulate fracture displacement. Axial rotation of the metacarpus was used to create oblique radiographic views. Radiographic images were generated with different angles and at several degrees of rotation of the bone. RESULTS: We deduced a mathematical formula that showed the true displacement of fractures of the neck of the fifth metacarpal bone by means of oblique radiographs. CONCLUSIONS: Oblique radiographs at 30° of supination provided the best view of the bone and least variation from the real value of the displacement of fractures of the fifth metacarpal bone. The mathematical formula deduced was concordant with the experimental model used.

OBJETIVO: Estabelecer uma forma indireta, fácil, previsível e segura na obtenção do valor real do desvio da fratura do colo do quinto metacarpo a partir de radiografias oblíquas. MÉTODOS: Uma peça anatômica de quinto metacarpo humano foi dissecada e submetida à ostectomia na região do colo. Um fio de Kirschner de 1 mm foi fixado perpendicular ao eixo longitudinal do osso e paralelo ao solo. Outros seis fios de Kirschner do mesmo diâmetro foram dobrados e presos ao osso ostectomizado para simular o desvio das fraturas. Rotação axial do metacarpo foi usada para criar as radiografias nas incidências oblíquas. Imagens radiográficas foram obtidas com diferentes ângulos e em vários graus de rotação do osso. RESULTADOS: Deduzimos uma equação matemática que demonstra o real desvio da fratura do colo do quinto metacarpo por meio de radiografias oblíquas. CONCLUSÕES: A radiografia oblíqua com 30° de supinação apresenta melhor visualização do osso e menor variação do valor real do desvio da fratura do colo do quinto metacarpo. A fórmula matemática deduzida foi concordante com o modelo experimental usado.

Supra-acetabular fixation and sacroiliac screws for treating unstable pelvic ring injuries: preliminary results from 20 patients / Tratamento das lesões instáveis do anel pélvico com fixador supra-acetabular e parafusos sacroilíacos: resultados preliminares em 20 pacientes

OBJECTIVE: To analyze the treatment results from 20 patients who underwent an alternative osteosynthesis method as definitive treatment for pelvic ring fractures. METHODS: A retrospective analysis was conducted on a series of 20 patients with pelvic ring fractures (Tile type C) and a high risk of postoperative infection, who were treated at Santa Casa de Misericórdia de São Paulo between August 2004 and December 2012. The patients underwent percutaneous supra-acetabular external fixation in association with cannulated 7.0 mm iliosacral screws. RESULTS: The patients' mean age was 40 years (range 22-77 years) and the mean length of follow-up was 18.5 months (range 3-69 months). At the end of the treatment, ten patients (50%) were classified as having good results, nine patients (45%) had fair results and one patient (5%) did not have any improvement. Six patients presented complications, and paresthesia of the lateral femoral cutaneous nerve was the most frequent of these (two patients). CONCLUSION: Supra-acetabular external fixation in association with iliosacral percutaneous osteosynthesis is a good definitive treatment method for patients with a high risk of postoperative infection.

OBJETIVO: Avaliar os resultados do tratamento de 20 pacientes que usaram como tratamento definitivo um método de osteossíntese opcional para fraturas do anel pélvico. MÉTODOS: Foi feita uma análise retrospectiva da série de 20 casos de pacientes com fratura do anel pélvico tipo C de Tile, portadores de alto risco de infecção pós-operatória, tratados na Santa Casa de Misericórdia de São Paulo entre agosto de 2004 e dezembro de 2012, submetidos a fixação externa supra-acetabular percutânea associada com parafusos canulados iliossacrais de 70 mm. RESULTADOS: A média de idade dos pacientes foi de 40 anos (mínimo de 22; máximo de 77) e o tempo médio de seguimento foi de 18,5 meses (mínimo de três; máximo de 69). Após o término do tratamento dez pacientes (50%) foram classificados com bons resultados, nove (45%) tiveram desfecho regular e um (5%) não apresentou melhoria alguma. Seis apresentaram complicações. A parestesia do nervo cutâneo femoral lateral foi a mais frequente (dois pacientes). CONCLUSÃO: A fixação externa supra-acetabular associada a osteossíntese percutânea iliossacral é um bom método de tratamento definitivo para os pacientes com alto risco de infecção pós-operatória.

PRP IN THE TREATMENT OF TROCHANTERIC SYNDROME: A PILOT STUDY.

OBJECTIVE: To compare the efficacy of platelet rich plasma (PRP) against corticosteroid on the treatment of trochanteric pain syndrome . METHODS: From July 2011 to November 2012, eighteen patients (20 hips) with trochanter pain syndrome were randomized in two groups and treated with platelet rich plasma or triamcinolone infiltration guided by ultrasound. Pain and function were evaluated prior to the intervention and after 10, 30 and 60 days, through the Facial Expressions Scale for Pain and the Western Ontario McMaster and Harris Hip Score questionnaires. Inter-group analysis was performed by Student t-test and intragroup analysis by ANOVA, followed by Bonferroni post hoc test. Statistical significance was set at p <0.05 . RESULTS: There was no difference between the groups. The triamcinolone group showed pain reduction (p=0.004) and improved function (p=0.036) through the Harris Hip Score questionnaire at 10, 30 and 60 days after treatment, when compared with the pre- intervention period. The platelet rich plasma group showed no statistical improvement in any of the variables . CONCLUSION: Up to 60 days, PRP infiltration has no influence on pain relief and function improvement in trochanteric syndrome treatment. Level of Evidence II, Prospective Comparative Study.