Quantitative Volumetric Measurements of Bone Grafting Sites Within the Lower Extremity on Computed Tomography Scans.

The anterior iliac crest is one of the most used options; however, pain and other complications have been reported. Other options for bone harvest in the lower extremity, such as the proximal tibia and calcaneus, can be useful sites for bone grafting. Computed tomography angiography images of the lower extremity were analyzed using 3-D Slicer™ medical imaging software, creating an advanced 3-dimensional model. Bone volume (cm3) and bone mineral density (Hounsfield units) were measured from the cancellous bone in the anterior iliac crest, posterior iliac crest, proximal tibia, and the calcaneus. Fifteen studies were included. The total volume measured it was of 61.88 ± 14.15 cm3, 19.35 ± 4.16 cm3, 32.48 ± 7.49 cm3, 26.40 ± 7.18 cm3, for the proximal tibia, anterior and posterior iliac crest, and calcaneus, respectively. Regarding Hounsfield units, the densities were 116 ± 58.77, 232.4 ± 68.65, 214.4 ± 74.45, 170.5 ± 52.32, for proximal tibia, anterior and posterior iliac crest, and calcaneus. The intraclass correlation coefficients were in average >0.94. In conclusion, the proximal tibia has more cancellous bone than the anterior and posterior iliac crest. The calcaneus has more cancellous bone than the anterior iliac crest. Bone mineral density was highest in the anterior iliac crest and in proximal tibia was the lowest value.

The use of platelet-rich plasma in studies with early knee osteoarthritis versus advanced stages of the disease: a systematic review and meta-analysis of 31 randomized clinical trials.

INTRODUCTION: Reports have concluded that platelet-rich plasma (PRP) is an effective and safe biological approach to treating knee osteoarthritis (OA). However, the effectiveness of PRP in advanced stages of the disease is not entirely clear. The purpose of this study was to evaluate whether the use of PRP would be as effective in studies with early-moderate knee OA patients compared to studies including patients with end-stage OA, based on the Kellgren-Lawrence classification. MATERIALS AND METHODS: A comprehensive search in MEDLINE, EMBASE, Scopus, and Web of Science databases was conducted to identify randomized controlled trials (RCTs) comparing the effect of PRP injections versus other intra-articular treatments on pain and functionality. A meta-analysis was conducted using a random-effects model and the generic inverse variance method. RESULTS: We included 31 clinical trials that reported data of 2705 subjects. Meta-analysis revealed an overall significant improvement of both pain [MD, - 1.05 (95% CI - 1.41 to - 0.68); I2 = 86%; P ≤ 0.00001] and function [SMD, - 1.00 (95% CI - 1.33, to - 0.66); I2 = 94%; P ≤ 0.00001], favoring PRP. Subanalysis for pain and functional improvement showed a significant pain relief in studies with 1-3 and 1-4 Kellgren-Lawrence OA stages and a significant functional improvement in studies with 1-2, 1-3 and 1-4 knee OA stages, favoring PRP. CONCLUSION: Our results indicate that including patients with advanced knee OA does not seem to affect the outcomes of clinical trials in which the effectiveness of the PRP in knee OA is assessed.

Comparison of Anterior Iliac Crest Versus Proximal Tibia Autologous Bone Graft Harvesting: A Systematic Review and Meta-Analysis.

Anterior iliac crest (AIC) is the preferred option for bone grafting; however, pain and complications are reported. Proximal tibia (PT) is a sourceful site for bone grafting with lower complications. MEDLINE, EMBASE, and Scopus were searched to identify studies comparing AIC and PT autograft procedure. The main outcome was pain and complication rate. As well as cadaveric and cell-based studies were analyzed for quantity and quality of AIC and PT autograft. A meta-analysis was performed using the generic inverse variance method with random or fixed effects model depending on heterogeneity between studies. Heterogeneity was tested with the I2 statistic index. Fifteen studies were included in the meta-analysis. Six studies and 248 patients were included for clinical outcomes. A significant pain reduction favoring PT at 24 hours was detected after meta-analysis and corresponding sensitivity analysis. The estimated effect size ranged from -2.31 to -2.93 cm, with confidence intervals aligned to the left indicating a robust steady decrease in pain across studies. This effect was not observed after 1 month. A total of 18 complications were reported, 13 in the AIC group and 5 in the PT group. Four cadaveric studies were included, 3 favored PT on the quantity of bone graft harvested. Five cell-based studies were included, only one study favored AIC for quality of bone graft. Our study concludes that PT bone harvest is a reliable option for bone grafting regarding morbidity, complications, volume graft obtained, and cellular and molecular properties. However, the current evidence is still insufficient to draw definitive conclusions, especially in terms of bone healing. PROSPERO Register: CRD42020198150.

Clinical Efficacy of Botulinum Toxin in the Treatment of Plantar Fasciitis: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

OBJECTIVE: To evaluate the efficacy of botulinum toxin A (BTX-A) for the treatment of plantar fasciitis through a meta-analysis of randomized controlled trials (RCTs) focusing on pain and functional outcomes since current literature has supported a potential benefit of BTX-A. DATA SOURCES: The MEDLINE, EMBASE, Web of Science, and Scopus databases were searched until December 2020 for RCTs reporting the effects of BTX-A injections on plantar fasciitis. The complementary literature search included Cochrane Central Register of Controlled Trials, Clinicaltrials.gov, and greylit.org. STUDY SELECTION: Only RCTs assessing the effect of BTX-A injections on pain, functional improvement, or plantar fascia thickness in patients with plantar fasciitis were included. Multiple researchers carried out the screening process of the 413 records. DATA EXTRACTION: Data were extracted independently and in duplicate using a standardized data extraction format. Information was contrasted by a third observer. DATA SYNTHESIS: BTX-A injections resulted in significant pain relief (mean difference, -2.07 [95% CI, -3.21 to -0.93]; P=.0004; I2=97%) and functional improvement (standardized mean difference, 1.15 [95% CI, 0.39-1.91]; P=.003; I2=87%). A subanalysis indicated that pain relief was sustained at 12 months while functional improvement remained significant after 0-6 months. The results were not affected by a single study after sensitivity analysis. The site of injection and the use or not of ultrasound-guided injections may account for potential sources of interstudy heterogeneity. CONCLUSIONS: This meta-analysis suggests both a statistically significant and a clinically meaningful improvement on plantar fasciitis symptoms after BTX-A treatment.

Distal radius fractures: Classifications concordance among orthopedic residents on a teaching hospital.

BACKGROUND: Several classification systems have been developed to support orthopedic surgeons regarding diagnostic, treatment, or prognostic outcomes of distal radius fracture (DRF). However, the best classification system for this fracture remains controversial. We aimed to identify the reliability of three different DRF classifications among orthopedists in training (medical residents). METHODS: Orthopedic residents (n = 22) evaluated thirty cases of DRF in anteroposterior and lateral projections in three different periods (0, 6, 12 months). Each radiography was sorted with three different classifications: Frykman, AO/OTA, and Jupiter-Fernandez. All assessments were blinded to the investigators. The inter- and intra-observer reliability was evaluated using the Cohen's kappa coefficient. An additional analysis was performed for a simpler sub-classification of the AO/OTA (27, 9, or 3 groups). RESULTS: Inter-observer agreement for AO/OTA, Frykman, and Jupiter-Fernandez classifications was slight (k = 0.15), fair (k = 0.31), and fair (k = 0.30), respectively. Intra-observer agreement showed similar results: AO/OTA, k = 0.14; Frykman, k = 0.28; and Jupiter-Fernandez, k = 0.28. When the AO/OTA classification was simplified (9 or 3 descriptions), the inter-observer agreement improved from slight (k = 0.16) to fair (k = 0.21 and k = 0.30, respectively). A similar improvement from slight (k = 0.14) to fair (k = 0.32 and k = 0.21) was detected for intra-observer agreement. CONCLUSIONS: The more complex the DRF classification system, the more complex is to reach reliable inter- and intra-observer agreements between orthopedic trainees. Senior residents did not necessarily show greater kappa values in DRF classifications.

Normal saline injection produces a therapeutic effect in patients with plantar fasciitis: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Injectable therapies have been increasingly investigated to treat plantar fasciitis in randomized controlled trials (RCT) where normal saline injections are frequently used as placebo. The purpose was to quantify the effect of saline injections and compared against available minimal clinically important difference (MCID) criteria specific for plantar fasciitis to assess if changes were clinically meaningful. METHODS: RCT including a placebo group (normal saline) and reporting changes in pain and functional outcomes in plantar fasciitis were identified through a search in MEDLINE, Embase, Web of Science, and Scopus to February 2022. PRISMA guidelines and a registered protocol (PROSPERO: CRD42020214035) were followed to conduct the study. RESULTS: Pooled analysis of 13 RCT (379 subjects) included for analysis revealed a significant improvement on pain (P < .00001) and functional scores (P < .00001) after normal saline injections. These changes exceeded the established MCID criteria. CONCLUSIONS: Normal saline injections in plantar fasciitis showed a therapeutic effect with statistically and clinically meaningful improvement when administered in the setting of an RCT for up to 12 months. The control of potential confounders influencing the effect of saline injections is required for future research.

Double-Row Rotator Cuff Repair Enhanced With Platelet-Rich Therapy Reduces Retear Rate: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

PURPOSE: To assess retear rates in arthroscopic double-row rotator cuff repair (double-row RCR) with and without platelet-rich therapy (PRT). METHODS: Systematic review and meta-analysis of randomized controlled trials (RCTs). MEDLINE, Embase, and Scopus databases were searched for RCTs involving use of PRT exclusively in arthroscopic double-row RCR. A random-effects model and the generic inverse variance method were used for quantitative data synthesis. Heterogeneity was tested with the I2 statistic index. RESULTS: The 9 RCTs included in the meta-analysis demonstrated a risk reduction of 49% for retears in patients receiving PRT (risk ratio [RR] 0.51; 95% confidence interval [CI] 0.35 to 0.76; P = .0008; I2 = 0%). Divided by tear sizes, retear risk reduction of 47% (RR 0.53; 95% CI 0.30 to 0.95; P = .03; I2 = 0%) was found in small to medium tears and 51% (RR 0.49; 95% CI 0.29 to 0.84; P = .009; I2 = 0%) in large to massive tears. Linked double-row RCR resulted in risk reduction of 51% for retears in comparison with nonlinked repairs. CONCLUSION: Double-row RCR plus PRT significantly reduced retear rates in all sizes of rotator cuff tears. Linked double-row RCR and applying the PRT during the surgical procedure and in the tendon-bone interface reproduced the best outcomes. Clinically, all patients improved, and no statistically significant difference was seen in clinical and functional scores between the intervention groups. All patients achieved optimal values for patient-reported outcomes measures. LEVEL OF EVIDENCE: I, systematic review and meta-analysis of level I studies.

Comparison of open arthrotomy versus arthroscopic surgery for the treatment of septic arthritis in adults: a systematic review and meta-analysis.

PURPOSE: To evaluate the efficacy of arthrotomy, when compared with arthroscopy, in the treatment of adults with septic arthritis of any joint. METHODS: MEDLINE, EMBASE, and Scopus were searched to identify studies comparing arthrotomy and arthroscopy as therapeutic approaches in patients with septic arthritis of any joint. The main outcome was the re-infection rate. A meta-analysis was performed using the generic inverse variance method with random or fixed effects model depending on heterogeneity between studies. Heterogeneity was tested with the I2 statistic index. RESULTS: Twenty studies with 10,249 patients treated by arthrotomy or arthroscopy were evaluated. We observed a significant lower risk of re-infection (odds ratio [OR], 1.35 [95% CI, 1.16-1.58]; p = 0.0002) and complications (OR, 1.32 [95% CI, 1.12-1.55]; p = 0.001) rate as well as less hospital stay (mean difference [MD], 0.57 days [95% CI, 0.10-1.05]; p = 0.02) favouring arthroscopic intervention. The subanalysis indicated that patients with knee (OR, 1.50 [95% CI, 1.17-1.92]; p = 0.001) and shoulder (OR, 1.24 [95% CI, 1.00-1.53]; p = 0.04) septic arthritis intervened by arthrotomy had a higher risk of re-infection. A lower number of hospitalization days (MD, 0.89 days [95% CI, 0.31-1.47]; p = 0.003) and a lower risk for complications (OR, 1.26 [95% CI, 1.04-1.52]; p = 0.02) were observed in patients treated with arthroscopy after septic knee arthritis. CONCLUSIONS: Available evidence suggests that patients with septic arthritis of the knee and shoulder treated by arthroscopy have less risk of re-infection than those treated by arthrotomy. The quality of the body of evidence is still insufficient to reach reliable conclusions. PROSPERO TRIAL REGISTRATION NUMBER: CRD42020176044. Date registration: April 28, 2020.

Treatment of lateral ankle sprain with platelet-rich plasma: A randomized clinical study.

BACKGROUND: We aimed to clinically evaluate the effect of platelet-rich plasma (PRP) therapy in patients with acute lateral ankle sprain treated with rigid immobilization. METHODS: Patients with first-time grade II lateral ankle sprain clinically diagnosed were evaluated (n=21). A rigid immobilization was placed in all patients for ten days; previously, an application of PRP over the anterior talofibular ligament was performed in patients from the experimental group. The Visual Analogue Scale, the American Orthopedic Foot and Ankle Score, and the Foot and Ankle Disability Index were applied at 3, 5, 8 and 24 weeks of follow-up period. RESULTS: The experimental group presented the highest reduction in pain and better functional scores than the control group at 8 weeks. At the end of follow-up period the results of both groups were similar. CONCLUSIONS: A similar evolution was observed in patients treated with rigid immobilization with or without PRP after 24 weeks. TRIAL REGISTRATION: Clinical Trials.gov with ID NCT02609308.

Effect of collagen supplementation on osteoarthritis symptoms: a meta-analysis of randomized placebo-controlled trials.

PURPOSE: Osteoarthritis (OA) is one of the most common causes of disability and a prevalent chronic disease. The use of collagen is growing due to the satisfactory results in the treatment of OA. However, the possible beneficial effects of collagen for the treatment of OA are currently controversial. The aim of the present meta-analysis was to evaluate the effect of collagen-based supplements on OA symptoms. METHODS: PubMed-Medline, Scopus, and Google Scholar databases were searched for randomized placebo-controlled trials evaluating the effect of orally administered collagen on OA symptoms using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale and/or the Visual Analog Scale (VAS). Meta-analysis was conducted using a random-effects model and a generic inverse variance method. Heterogeneity was tested using the I2 statistic index. RESULTS: Collagen treatment showed a significant reduction in the score of total WOMAC index (WMD - 8.00; 95% CI - 13.04, - 2.95; p = 0.002). After subgroup analysis of the WOMAC subscores, the collagen supplementation revealed a significant decrease in the stiffness subscore (WMD - 0.41; 95% CI - 0.74, - 0.08; p = 0.01), whereas the pain (WMD - 0.22; 95% CI - 1.58, 1.13; p = 0.75) and functional limitation (WMD - 0.62; 95% CI - 5.77, 4.52; p = 0.81) subscores did not have significant differences. Finally, a significant reduction was found in the VAS score after collagen administration (WMD - 16.57; 95% CI - 26.24, - 6.89; p < 0.001). CONCLUSION: The results of this meta-analysis showed that collagen is effective in improving OA symptoms by the decrease of both total WOMAC index and VAS score.

Investigation of the Association Between the Acute Ankle Injury Caused by Fall From Own Height and Body Mass Index.

In the emergency settings, increased body mass index (BMI) is a risk factor for traumatic orthopedic injuries. The aim of this study was to assess the association between the acute ankle injuries (sprain or fracture) and BMI. This prospective cohort study included patients ≥18 years of age with acute traumatic ankle injuries (either sprain or fracture) caused by fall from own height when walking at ground level and who received primary treatment at the emergency room of a university hospital between May and October 2017. Of the 107 patients who met the inclusion criteria, 58 (54%) patients experienced acute ankle sprains and 49 (46%) experienced acute ankle fractures. No significant association was detected between fracture severity (as assessed by the Danis-Weber classification) and BMI (p = .860). The most frequent ankle injury in patients with normal BMI was ankle sprain. In our cohort, obesity was not the primary determinant of the severity of ankle injury. However, age was a key determinant of the type of injury; patients >30 years of age were 20% more likely to suffer an ankle fracture.

Effect of glucosamine and chondroitin sulfate in symptomatic knee osteoarthritis: a systematic review and meta-analysis of randomized placebo-controlled trials.

Although glucosamine and chondroitin sulfate have showed beneficial effects on joint tissues in osteoarthritis (OA), their therapeutic use in the clinical setting is still debatable. Hence, a systematic review and meta-analysis of randomized placebo-controlled trials was conducted to investigate the efficacy of glucosamine and chondroitin sulfate on knee OA symptoms. Medline, SCOPUS, Web of Science, and Google Scholar databases were searched for randomized placebo-controlled trials evaluating the effect of orally administered glucosamine and/or chondroitin sulfate on OA symptoms using the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) and/or the Visual Analog Scale (VAS). Meta-analysis was conducted using a random-effects model and generic inverse-variance method. Heterogeneity was tested using the I2 statistic index. Treatments with glucosamine and chondroitin were found to significantly reduce pain in VAS [weighted mean difference (WMD) - 7.41 mm, 95% CI - 14.31, - 0.51, p = 0.04 and WMD - 8.35 mm, 95% CI - 11.84, - 4.85, p < 0.00001, respectively]. Their combination did not show this behavior (WMD - 0.28 mm, 95% CI - 8.87, 8.32, p = 0.95). None of the glucosamine, chondroitin or their combination had a significant positive effect on the total WOMAC index and its subscores. Oral supplementation with glucosamine or chondroitin sulfate reduces pain in knee OA. However, there is no additional effect using both therapeutic agents in combination for the management of symptomatic knee OA.

Delayed union of humeral shaft fractures: comparison of autograft with and without platelet-rich plasma treatment: a randomized, single blinded clinical trial.

INTRODUCTION: Despite an adequate orthopedic treatment with functional bracing, some patients develop a delayed union in humeral shaft fractures. The objective of the present study was to determine the bone consolidation time among patients with delayed union of diaphyseal humeral fractures who were managed with locking compression plate (LCP) fixation combined with an iliac crest autograft using platelet-rich plasma (PRP) as a co-adjuvant. MATERIALS AND METHODS: This study was a controlled, randomized, experimental, longitudinal, comparative, prospective, blind clinical trial. Patients diagnosed with delayed union of a diaphyseal humeral fracture with at least 4 months of evolution were treated with an open reduction and LCP osteosynthesis combined with an iliac crest autograft. The experimental group also received PRP. The patients were assessed radiographically until 36 weeks of evolution. RESULTS: A total of 16 patients were included. Both groups had similar demographic characteristics. The patients treated with PRP had an earlier beginning of bone consolidation. Furthermore, these same patients exhibited bone consolidation at 19.9 weeks, on average, in contrast to 25.4 weeks in the control group. CONCLUSIONS: The use of PRP promotes earlier bone consolidation in patients with delayed union of the humeral shaft.

Laser Treatment on Acupuncture Points Improves Pain and Wrist Functionality in Patients Undergoing Rehabilitation Therapy after Wrist Bone Fracture. A Randomized, Controlled, Blinded Study.

The objective of this study was to determine whether application of laser beam on acupuncture points has a positive effect on the rehabilitation of patients with a diagnosis of distal radius fracture (1.5 inches proximal to distal articular surface of the radius) when applied with active conventional physical therapy exercises. Patients with a distal radius fracture treated with closed reduction, percutaneous pinning, and a short cast for six weeks was included and were assigned to one of two study groups. The control group was given simulated laser acupuncture with the laser off, while the experimental group received laser beam on acupuncture points. A low power infrared 980 nm, 50 mW laser (Diller & Diller Laser Performance) electric energy, was used; each acupuncture point was irradiated for 30 seconds at 8,000 Hz at each therapy session. In both groups, treatment was applied to the following points: Ipsilateral- Yanggu (S15), Yangchi (SJ4), Waiguan (SJ15), Yangxi (LI5), Daling (PC7); Bilateral- Hegu (L14); Contralateral- Shenmail (VL62), Kulun (V60), Taixi (KID3). All of the patients underwent a total of 10 sessions, at a frequency of three times per week. They were evaluated using the VAS, the Patient-Rated Wrist Evaluation (PRWE), and wrist mobility ranges at the beginning of treatment, at the end of the fifth session, at the 10th session, and a week after the 10th session. The patients treated with laser beam exposure on acupuncture points showed 44% reduction in pain and 33% of improvement in the functional status of the wrist compared with the control group. Application of laser beam on acupuncture points combined with active rehabilitation exercises show benefits in the rehabilitation of patients with a distal radius fracture managed with percutaneous pinning and a short cast.

Tibial tubercle osteotomy in septic revision total knee arthroplasty.

PURPOSE: The incidence of revision knee arthroplasty for infection is increasing and the required surgical approach for the revision is a challenge for surgeons. Extensile approaches are frequently used when it is impossible to evert the extensor mechanism. The aim of this paper is to report our experience with tibial tubercle osteotomy (TTO) and the functional results in patients who underwent a two-stage revision due to prosthesis infection. METHODS: Twenty-six patients underwent a TTO as a surgical approach in the second stage of revision for infection. The patients were clinically assessed by means of functional scales (the Knee Society Score and WOMAC) and X-rays. RESULTS: The TTO healed without complications in 22 patients (84.6%) and the average length of follow-up was 3.4 years. Non-union was observed in two patients. One patient presented an extension lag of 5°. A total of 23 patients (88.4%) were free from infection. Twenty-five patients (96.1%) had better scores on the Knee Society Score and WOMAC after the procedure. CONCLUSIONS: In patients undergoing the second stage of revision total knee arthroplasty for infection, the TTO approach provides a large operating field. This enables surgeons to withdraw spacers and position new implants without damaging the extensor mechanism of the knee or altering the postoperative rehabilitation process. The complications that have been reported as a result of this procedure could be reduced by performing a meticulous surgical technique. LEVEL OF EVIDENCE: Retrospective case series, Level IV.

A comparison of botulinum toxin a and intralesional steroids for the treatment of plantar fasciitis: a randomized, double-blinded study.

BACKGROUND: The objective of this study was to compare intramuscularly applied botulinum toxin A (BTX-A) in the gastroc-soleus complex with intralesional steroids for the treatment of plantar fasciitis. METHODS: The patients were randomly divided into 2 groups according to the treatment received. The patients were evaluated over 6 months. The evaluation scores included the Visual Analog Scale (VAS), Maryland Foot and Ankle, Foot and Ankle Disability Index (FADI), and American Orthopaedic Foot and Ankle Society (AOFAS) score. Moreover, patients were instructed to perform plantar fascia stretching exercises over the course of the study. The final number of patients was 36, of whom 19 received BTX-A (10 men and 9 women) and 17 (6 men and 11 women) received steroids. RESULTS: When compared to patients who received steroids, the patients who received BTX-A exhibited more rapid and sustained improvement over the duration of the study. CONCLUSION: A combination of BTX-A and plantar fascia stretching exercises yielded better results for the treatment of plantar fasciitis than intralesional steroids. LEVEL OF EVIDENCE: Level I, therapeutic studies.

Platelet-Rich Plasma for Knee Osteoarthritis: What Does the Evidence Say?

The utilization of platelet-rich-plasma as a therapeutic intervention for knee osteoarthritis has gained immense attention since 2008. The increase in the number of scientific publications dedicated to this area can be attributed to the majority of favorable results reported in clinical trials and basic science studies. However, despite the growing evidence, the use of platelet-rich plasma in clinical practice still poses controversial aspects. The potential mechanisms of action described for platelet-rich-plasma so far indicate that it could serve as a disease-modifying drug, acting to counteract important aspects of knee osteoarthritis pathophysiology (cartilage breakdown, inflammation, and bone remodeling). Nevertheless, its efficacy in slowing down the progression of knee osteoarthritis remains unproven. While inconsistencies have been noted, the majority of controlled clinical trials and meta-analyses advocate for the utilization of platelet-rich-plasma in treating knee osteoarthritis, as it has demonstrated greater efficacy than hyaluronic acid and placebo, with a follow-up of at least 1 year. Despite advancements made in certain areas, significant diversity persists regarding the formulations used, therapeutic regimen, extended follow-up periods, patient selection, and assessment of clinically relevant outcomes. Consequently, the leading clinical practice guidelines do not recommend its use. In light of the emerging evidence, this narrative review aims to provide an objective evaluation of the recent available scientific literature (last 5 years) focused on randomized clinical trials and meta-analyses to present a current overview of the topic.

Supracondylar humeral fractures and lateral elbow condyle fractures in children: association between body weight, clinical signs, and fracture severity.

BACKGROUND: The objective of our study was to investigate the association between body weight, clinical signs and surgical time, and the severity of elbow fractures sustained exclusively by a ground-level fall in children. METHODS: Patients aged 2-11 years with elbow fracture caused exclusively by a ground-level fall were included. BMI was plotted on the sex-specific BMI-for-age percentile growth chart to obtain the BMI percentile. The elbow fractures were classified according to Gartland Classification for supracondylar fractures and the Song Classification for lateral humeral condyle fracture. Our main outcome measurement was Body Mass Index and fracture severity according Gartland or Song classifications. RESULTS: A total of 175 patients with elbow fractures were included in this study. The mean age of total population was 5.4 years (±2.4). The majority of our patients were male (61.7%), nearly of 48% were overweight or obese patients. The ecchymosis and puckering were the clinical sign more frequent in more severe fractures. CONCLUSIONS: Our data presented did not observe a direct relation between obesity and the severity of elbow humeral fractures in the pediatric population with a ground-level fall.

The Effects of the Combination of Rhein and Platelet-Rich Plasma on Human Articular Chondrocytes.

BACKGROUND: The presence of side effects and low bioavailability of rhein has limited its use in the treatment of osteoarthritis. We aimed to evaluate the in vitro response of human articular chondrocytes to the presence of the combination of platelet-rich plasma (PRP) and rhein. METHODS: Solutions of rhein were prepared to assess solubility and select a working concentration. A stimulus with interleukin-1ß (IL-ß, 10 ng/mL) was induced for 24 h on human chondrocytes. Five treatment groups were established: control, IL-ß control, PRP, rhein, and PRP + rhein. Cell viability, cell migration, nitric oxide (NO) production, tumor necrosis factor-α (TNF-α), and gene expression analyses were carried out. RESULTS: A concentration of 50 mg/L was selected after a dose-response curve assay. Both NO and tumor TNF-α production significantly decreased after PRP and PRP + rhein treatments at 24 and 48 h. The wound healing assay revealed a significant stimulation of migration after 72 h with the PRP and PRP + rhein treatments. Expression of IL-1ß, IL-6, MMP-13, and ADAMTS-5 was significantly downregulated, particularly after treatment with the combination of PRP + rhein. CONCLUSIONS: Much of the determinations denoted a better performance of the combination of PRP and rhein in decreasing the levels of the different targets evaluated; however, this was not great enough to detect a significant difference in comparison with the PRP treatment alone.

Clinical efficacy of botulinum toxin in lateral elbow tendinopathy: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Botulinum toxin injections for lateral elbow tendinopathy have been used as an alternative therapeutic option. However, few studies have quantitatively summarized the effect of botulinum toxin as well as its clinical significance. We aimed to evaluate the clinical efficacy (based on pain and grip strength) and adverse events of botulinum toxin on lateral elbow tendinopathy. PATIENTS AND METHODS: The MEDLINE, EMBASE, Web of Science, and Scopus databases were searched until March 2023 for randomized controlled trials reporting the effects of botulinum toxin injections on lateral elbow tendinopathy. A random- or fixed-effects model (depending of inter-study variability) and generic inverse variance method were used to pool quantitative data from outcomes. The risk of bias was assessed with the Cochrane Risk of Bias 2.0 tool. RESULTS: A total of 8 clinical trials recruiting 438 subjects were included for meta-analysis. Pooled analysis revealed that botulinum toxin significantly reduced pain (mean difference [MD] -0.95, 95% CI [-1.63, -0.26], p=0.007) but it was not clinically relevant. No significant effect was detected for grip strength (MD-0.62kg, 95% CI [-2.25, 1.02], p=0.46) or in the risk for adverse events (odds ratio [OR] 0.41, 95% CI [0.05, 3.56], p=0.42) between botulinum toxin injection and control interventions. DISCUSSION: The use of botulinum toxin reached greater pain relief than control interventions and normal saline after a period of 12 to 24 weeks. However, changes in pain relief did not reach clinical significance. The studies that had the greatest reduction in pain used higher doses of botulinum toxin (60 U). Additionally, differences in grip strength and adverse events did not reach statistical or clinical importance. A subanalysis indicated that botulinum toxin outperformed corticosteroid injections in terms of improving grip strength. Botulinum toxin only causes local and minimal side effects such as irritation, ecchymosis, and paralysis. LEVEL OF EVIDENCE: I.