Comparison of Topical Oxygen with Vacuum Assisted Closure in Wound Healing in a Low Resource Setting

The aim of this pilot study is to obtain preliminary results comparing topical oxygen therapy (TOT) and vacuum assisted closure (VAC) in terms of its ability to accelerate wound healing. METHODS: This non-randomised prospective study included patients with age 16-50 years, wound size ≥ 16cm2 and present below knee joint within seven days of occurrence. Bates-Jensen wound assessment tool (BWAT) was used for evaluation at 8-day interval along with percent area reduction at final follow up. RESULTS: Mean number of cycles required in VAC and TOT group were 1.97 (range 1-3) and 2.1 (range 1-3) (each cycle of 5 days) per patient respectively. Percent area reduction was significantly higher in the VAC group (34±9.7%) than TOT (11.3±3.8%) group at final follow up (p<0.05). TOT patients had better improvement in epithelialization compared to VAC at last follow up. More extensive debridement was needed in patients of TOT than VAC. There was no significant difference between final score in both groups. CONCLUSION: TOT appears to be comparable to well-established VAC in treatment of fresh traumatic wounds below the knee joint. Further large scale, multicentric and randomised studies comparing both these modalities of treatment should be the way forward

Functional outcome of resection versus reconstruction in mason II-III radial head fractures; a short-term prospective study

Objective: to compare the short-term functional outcome between resection and reconstruction in Mason Type II and Type III radial head fractures using Broberg and Morrey score

Methods: a prospective cohort study was conducted in the Department of Orthopedic Surgery of SMS Medical College and attached Hospitals. A total of 29 patients [15 in resection group, 14 in reconstruction group] between the age group of 20-60 years with Mason Type II and Type III fresh closed radial head fractures were included in the study. The functional outcome including the range of motion, extension lag and Broberg Morrey score were determined and compared between two groups

Results: the mean age of resection group was 44.5+/-6.6 years and mean age of reconstruction group was 37.1+/-6.2 years. The baseline characteristics . At 12-months follow-up, in Mason type II fracture, radial head reconstruction group with mean extension lag of 9.4+/-4.1 and mean Broberg Morrey score of 94.9+/-5.1 showed better results compared to radial head resection group with mean extension lag of 15.7+/-4.1 [p=0.022] and mean Broberg Morrey score of 88.3+/-5.1 [p=0.045] respectively. In Mason type III fractures, radial head resection with mean supination of 79.4+/-4.7, mean pronation of 74.4+/-4.1 and mean Broberg Morrey score of 89.8+/-6 showed better results when compared with radial head reconstruction group with mean supination of 64.2+/-4 [p<0.001], mean pronation of 59.2+/-8.4 [p=0.003] and mean Broberg Morrey score of 81.9+/-5 [p=0.031]

Conclusion: the procedure suggested in Mason type II, is reconstruction of radial head. In Mason type III due to difficulty in achieving anatomical reduction results were not good with reconstruction when compared with resection. We recommend radial head excision in Mason type III fractures where anatomical and stable fixation is not possible