A Comparison of Anteromedial Plating Versus Anterolateral Plating for Humerus Shaft Fractures Using the Anterolateral Approach.

Background Plate osteosynthesis is the gold standard treatment for the management of humeral shaft fractures. In the present study, we performed plate osteosynthesis on the anteromedial and anterolateral surfaces using the anterolateral approach to compare the functional outcomes. Aims and objectives To study and compare the functional outcome, time to achieve union and associated complications of anteromedial and anterolateral plating in humerus shaft fracture by anterolateral approach. Methods This prospective, randomised control study was performed at Dr Baba Saheb Ambedkar Medical College and Hospital, New Delhi, India. This study had 46 patients in total, who were divided into two equal groups at random. All of the fractures in group A were treated using a limited contact dynamic compression plate (LCDCP) on the anterolateral surface using an anterolateral approach, while all of the fractures in group B were corrected using an anteromedial surface using an anterolateral approach using LCDCP. All the patients were followed for six months at regular intervals. At each follow-up, patients were assessed radiologically with X-rays and clinically by Rodriguez-Merchan criteria (RM criteria). Results and conclusions The union was achieved in the majority of the cases of the anteromedial plating group within 12 weeks (78.3%) with a mean union time of 11.7±1.5 weeks than the anterolateral group (56.5%) with a mean union time of 12.3±1.8 weeks. Based on functional assessment according to RM criteria, the excellent outcome was achieved in 69.6% and 65.2% of the anterolateral and anteromedial plating groups, respectively. There was no case of non-union and radial nerve palsy in anteromedial plating cases whereas in anterolateral cases one patient did not achieve union and two (8.7%) had radial nerve injury, which recovered completely by the end of the study. An anterolateral approach with anteromedial surface plating on the flat medial aspect of the humerus is a good technique for fixing humeral fractures.

Efficacy of Autologous Conditioned Serum (ACS), Platelet-Rich Plasma (PRP), Hyaluronic Acid (HA) and Steroid for Early Osteoarthritis Knee: A Comparative Analysis.

BACKGROUND: Intra-articular injection therapy constituting corticosteroids, viscosupplements and blood-derived products are considered to have a key role in non-operative management of osteoarthritis knee. While corticosteroids and viscosupplements have proven short-term efficacy in early osteoarthritis; orthobiologics are gaining increased attention in osteoarthritis management. The aim of present study was thus to compare two commonly used biologics (platelet-rich plasma/PRP and autologous conditioned serum/ACS) to each other and to established therapies. METHODS: After required institutional clearances, all patients presenting with early primary osteoarthritis knee who had failed initial conservative management and received only unilateral knee injection were included. Patients in the PRP group were compared to the other groups (comprising the HA/hyaluronic acid group, steroid group, and a matched cohort who had been administered ACS for the same indication earlier). Clinical outcome was evaluated using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire and Visual Analogue scale (VAS) pre-injection and at 6 months. RESULTS: ACS and PRP did not have any significant difference in terms of either WOMAC score (p = 0.154) or VAS score at 6 months (p = 0.850). The scores for both these orthobiologics were better than the control groups (HA group and Steroid group). Between the two control groups, HA group had better VAS scores as compared to the Steroid group (p = 0.008). CONCLUSION: The clinical outcomes following intra-articular injection of ACS and PRP are better than controls (HA and steroid), but a difference between the two orthobiologics could not be demonstrated. LEVEL OF EVIDENCE: 3b.

Closed Transverse Pinning for Reduction and Fixation of Metatarsal Neck Fractures: Surgical Technique.

Most metatarsal neck fractures can be successfully treated non-operatively in a cast boot. Displaced metatarsal neck fractures tend to be less stable and have a propensity for the distal fragment to angulate, secondary to the strong flexor tendons, which often forces the distal fracture fragment in a plantar direction and leads to relative metatarsal shortening. Most literature is focussed on antegrade fixation of metatarsal neck fractures using pre-bent K wires or thin elastic nails. Apart from the technical challenges, this technique is limited when bones are osteoporotic as the pre-bent distal end of the K-wire may penetrate the plantar cortex of the proximal metatarsal and prevent the wire from entering the medullary canal of the metatarsal and advancing to the fracture site. Furthermore, when the medullary canal is narrow especially in Asian patients, it may be difficult to pass a bent K-wire through the isthmus of the metatarsal shaft. We describe an innovative technique of closed transverse wiring of the metatarsal head necks that has a distinct advantage in Asian population with osteoporotic bones. With percutaneous manipulation using digital pressure, closed reduction of fracture fragments of the most displaced fracture is done under fluoroscopic guidance to achieve a satisfactory alignment followed by closed transverse wiring of the metatarsal heads. With this procedure, adjacent fractures remain stable within an acceptable range because of intermetatarsal ligaments connected to the adjacent intact head. Our technique has a relatively short operating time and allows for early motion of the metatarso-phalangeal joint. This is especially useful for those with osteoporosis, narrow canal, soft tissue compromise, intra-operative failure of ante-grade pinning and in scenarios of limited surgical equipment/expertise.

Comparison of midterm results of Platelet Rich Plasma (PRP) versus Steroid for plantar fasciitis: A randomized control trial of 118 patients.

BACKGROUND: Plantar fasciitis, which is a common cause of heel pain, often results in significant morbidity. In cases who are not responsive to initial conservative treatment, invasive procedures, often in the form of local infiltration of steroid are required. These procedures are associated with significant complications. Local Platelet Rich Plasma (PRP) infiltration is an emerging addition to these treatments. However, whether it is more effective in reducing pain and improving function than other treatments (such as steroid injections or whole blood) remains controversial. METHODS: Skeletally mature patients with plantar fasciitis who had failed conservative therapy were randomized using envelope method into 2 groups: PRP and Steroid group. The participants were assessed for pain using Visual Analog Scale on the day of presentation, and then after therapy at 2 weeks, 4 weeks, 3 months, and 6 months. They were additionally assessed on final follow-up using AOFAS hind-foot Score. RESULTS: 118 patients were randomized into 2 groups: 58 patients to the PRP group and 60 to the Steroid group. PRP was associated with greater improvement in VAS score and resulted in superior AOFAS score at 6 months as compared to steroid injection. The authors did not find any local or systemic complications in any of the groups. The result and difference were more pronounced as the time from injection increased and maximal benefit was observed at 6 months follow-up. None of the patients needed a repeat injection at 6 months. CONCLUSION: Our study expands on the previous studies to provide a better evidence for superiority of PRP over local injection of steroid in plantar fasciitis, and the authors conclude that PRP provides better pain relief and function as compared to steroid injection. LEVEL OF EVIDENCE: Level 1 Prospective Randomized Control Trial (RCT).

Influence of Albizia lebbeck Saponin and Its Fractions on In Vitro Gas Production Kinetics, Rumen Methanogenesis, and Rumen Fermentation Characteristics.

The present study was undertaken to investigate the effect of crude seed powder (CSP) and gross saponins extract (GSE) of seeds of Albizia lebbeck on antimicrobial activity by taking two Gram-positive (Staphylococcus aureus and Bacillus cereus), two Gram-negative (Escherichia coli and Salmonella Typhi) bacteria, and two fungi species (Aspergillus niger and Candida butyric) were taken at 25, 50, 100, 250, and 500 µg levels using agar well diffusion method. Zone of inhibition was increased with increasing of concentration of CSP and saponins which indicates that Gram-negative bacteria (E. coli), Gram-positive bacteria (B. cereus), and A. niger were significantly susceptible to inhibition. Another experiment was conducted to study the effect of GSE and saponins fraction A and B of A. lebbeck supplementation at 6% on DM basis on methane production and other rumen fermentation parameters using in vitro gas production test, by taking three different type diets, that is, high fiber diet (D1, 60R : 40C), medium fiber diet (D2, 50R : 50C), and low fiber diet (D3, 40R : 60C). Significant (P ≤ 0.05) increase was seen in IVDMD, methane production; however ammonia nitrogen concentration decreased as compared to control. The methane production was reduced in a range between 12 and 49% by saponin supplemented diets except in case of GSE in D2. Sap A showed the highest methane reduction per 200 mg of truly digested substrate (TDS) than other treatment groups. Results in relation with quantification of methanogens and protozoa by qPCR indicated the decreasing trend with saponins of A. lebbek in comparison with control except total methanogen quantified using mcr-A based primer.

Salvage of proximal tibia fracture treated with locked compression plate.

The treatment of displaced proximal tibial fractures is challenging. Recent developments in the techniques of internal fixation, including the development of locking plates and minimally invasive surgical techniques have revolutionaries the treatment of such fractures. We present a case of proximal displaced tibial fracture that was treated with anatomical proximal tibial locking plate using minimally invasive percutaneous plate osteosynthesis. Patient made uneventful recovery even after he sustained re-injury and plate bending and was manipulated under anaesthesia for the same.

Response of fumaric Acid addition on methanogenesis, rumen fermentation, and dry matter degradability in diets containing wheat straw and sorghum or berseem as roughage source.

An in vitro incubation system was used to evaluate effect of supplementation of fumaric acid at 0, 5, 10, and 15 mM concentration in high-, medium-, and low-fiber wheat straw containing total mixed diets with sorghum (Sorghum vulgare) and berseem clover (Trifolium alexandrinum L.) on rumen fermentation, methane production, and gas kinetics parameters. Three types of diets were prepared with different roughage and concentrate ratio (80 : 20, 50 : 50, and 20 : 80) by taking the representative samples. The roughage part composed of wheat straw (70 parts) and sorghum (30 parts) or berseem (30 parts) and the concentrate part composed of maize (33%), GNC (21%), mustard cake (12%), wheat bran (20%), deoiled rice bran (11%), mineral mixture (2%), and salt (1%). Fumaric acid was added in incubation medium to achieve final concentration of 0, 5, 10, and 15 mM. All the treatment combinations were arranged in 4 × 3 factorial designs with three replicates. It was concluded from the study that fumaric acid addition (5-15 mM) in diets varying in roughage to concentrate ratio significantly (P ≤ 0.05) reduced the methane production without affecting dry matter digestibility and maximum reduction was noticed at 5 mM concentration.

A method to localize the radial nerve using the 'apex of triceps aponeurosis' as a landmark.

BACKGROUND: The relationship of the radial nerve is described with various osseous landmarks, but such relationships may be disturbed in the setting of humerus shaft fractures. Alternative landmarks would be helpful to more consistently and reliably allow the surgeon to locate the radial nerve during the posterior approach to the arm. QUESTIONS/PURPOSES: We investigated the relationship of the radial nerve with the apex of triceps aponeurosis, and describe a technique to locate the nerve. MATERIALS AND METHODS: We performed dissections of 10 cadavers and gathered surgical details of 60 patients (30 patients and 30 control patients) during the posterior approach of the humerus. We measured the distance of the radial nerve from the apex of the triceps aponeurosis along the long axis of the humerus in cadaveric dissections and patients. This distance was correlated with the height and arm length. For all patients, we recorded time until first observation of the radial nerve, blood loss, and postoperative radial nerve function. RESULTS: The mean distance of the radial nerve from the apex of the triceps aponeurosis was 2.5 cm, which correlated with the patients' height and arm length. The mean time until the first observation of the radial nerve from beginning the skin incision was 6 minutes, as compared with 16 minutes in the control group. Mean blood loss was 188 mL and 237 mL, respectively. With the numbers available, we observed no difference in the incidence of patients with postoperative nerve palsy: none in the study group and three in the control group. CONCLUSION: The apex of the triceps aponeurosis appears to be a useful anatomic landmark for localization of the radial nerve during the posterior approach to the humerus.