Case Series: Wide-Awake Local Anaesthesia Without Tourniquet (WALANT) for Camitz Transfer.

Background: Wide-Awake Local Anaesthesia Without Tourniquet (WALANT), with the benefit of simplicity and a low complication rate, is a well-recognised procedure in orthopaedic surgery. To date, there is no report using WALANT technique with the Camitz transfer procedure. The aim of this study is to determine the early outcomes of using WALANT for Camitz transfer and compare these with outcomes of similar procedures in literature. Methods: Between January 2012 and January 2018, all patients with severe carpal tunnel syndrome (CTS) with thenar muscle atrophy who underwent the Camitz transfer procedure as day surgery under the WALANT technique at the Thammasat University Hospital were included. With the WALANT technique, the 10 mL of prepared anaesthesia was injected into the area around the palmaris longus tendon from 5-cm proximal to the distal wrist crease to the distal palmar crease, while an additional 10 mL was injected from the radial side of the metacarpophalangeal joint of the thumb to the distal wrist crease before the operation. Upon completion of the operation, the patients' hand was placed in a thumb spica splint. Patient demographic data, visual analogue scale (VAS) during injection and during procedure, operative time, blood lost and complications were recorded. Results: Thirty-six patients (8 males and 28 females) were included. The average age of the patients was 65.9 (37-87) years old. The average VAS score during the anaesthetic injection was 6.22 (5-8). The average VAS pain score during the operation was 0.52 (0-3). The average operative time was 27.06 (17-47) minutes. The mean intraoperative blood loss was 3 (2.4-6.8) mL. All patients underwent the procedure without any complications. Conclusions: The WALANT technique is safe and can be used as alternative anaesthesia for the Camitz transfer. Level of Evidence: Level IV (Therapeutic).

The Efficacy of Ruesi Dadton and Yoga on Reducing Neck and Shoulder Pain in Office Workers.

Work-related Musculoskeletal Disorders can cause neck and shoulder pain in office workers. The research objective was to investigate the efficacy of Ruesi Dadton exercise (RD) and Yoga exercise (YE) compared with Stretching exercise (SE) on reducing neck and shoulder pain in office workers. A single-blind randomized controlled trial was conducted at Thai Traditional Health Promotion Center, Thai Traditional and Alternative Medicine Hospital. A total number of 80 participants, equally divided into three groups: two intervention groups of RD (n=26), YE (n=28), and a control group of stretching exercise (SE) (n=26) who completed the 4-week intervention program. The primary outcomes were pain relief assessed by Visual Analog Scale, Pressure Pain Threshold, muscle flexibility by Cervical Range of Motion. The secondary outcome was World Health Organization's Quality of Life test. ANOVA, paired t-tests and repeated ANOVA were used to analyze the data. The results showed that the comparison of all three groups before and after the exercises revealed a decrease in pain, better tolerance to pain and more flexibility of the neck muscles with statistical significance (p< 0.05). With respect to the quality of World Health Organization's Quality of Life, the comparison of all four domains in all three groups before and after the exercises indicated a statistically significant improvement in quality of life (p< 0.05). However, there were no differences in pain, neck muscle flexibility and quality of life between groups.

Arthroscopic Treatment of Scaphoid Nonunion With Olecranon Bone Graft and Screw Fixation Leads to Union and Improved Outcomes.

PURPOSE: To evaluate the outcomes of arthroscopic treatment of scaphoid nonunion using olecranon bone graft and screw fixation and to analyze the outcomes in accordance with variations in the chronicity, location, and severity of nonunion. METHODS: Between March 2012 and December 2020, patients with diagnoses of scaphoid delayed nonunion and nonunion with substantial bone resorption (Slade and Dodds grade IV-VI) underwent arthroscopic-assisted olecranon bone graft and screw fixation. Preoperative and postoperative measurements included the visual analog scale score for pain; range of motion; grip strength; the Modified Mayo Wrist Score; the Disabilities of the Arm, Shoulder and Hand (DASH) score; and the minimal clinically important difference for the DASH score. Union rate and duration were also evaluated. The outcomes between groups of patients with different conditions were analyzed. RESULTS: Twenty-two patients were included. The average follow-up period was 32.5 months. The visual analog scale pain score, range of motion, grip strength, Modified Mayo Wrist Score, and DASH score were significantly improved after surgery (P < .001). The minimal clinically important difference threshold for the DASH score was reached by 100% of patients. At final follow-up, all patients had united scaphoid with no complications. The average time to union was 15.3 weeks. Group analysis showed significant improvements in mean grip strength between patients with delayed union (3-6 months) and those with chronic nonunion (> 1 year) (17.75 kg vs 12.25 kg, P = .032), between grade IV nonunion and grade V nonunion (14.86 kg vs 10.43 kg, P = .035), and between grade V nonunion and grade VI nonunion (10.43 kg vs 15.63 kg, P = .013). Patients with grade VI nonunion achieved union at 17.8 weeks postoperatively, a significantly longer period than that for patients with grade IV nonunion (11.4 weeks, P = .014). CONCLUSIONS: Arthroscopic treatment of scaphoid nonunion using olecranon bone graft and screw fixation provided satisfactory outcomes regardless of the chronicity, location, and severity of nonunion. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Hand Surgery in Thailand.

Modern hand surgery in Thailand started after the end of World War II. It is divided into 4 phases. In the initial phase (1950-1965), the surgery of the hand was mainly performed by general surgeons. In 1965-1975, which was the second phase, many plastic surgeons and orthopaedic surgeons graduated from foreign countries and came back to Thailand. They played a vital role in the treatment of the surgery of the hand and set up hand units in many centers. They also contributed to the establishment of the "Thai Society for Surgery of the Hand," which still continues to operate. In the third phase (1975-2000), there was a dramatic development of microsurgery because of the rapid economic expansion. There were many replantation, free tissue transfers, and brachial plexus surgeries in traffic and factory-related accidents. The first hand-fellow training program began in 1993. In the fourth phase (since 2000), the number of hand injuries from factory-related accidents began declining. But the injury from traffic accidents had been increasing both in severity and number. Moreover, the diseases of hand that relate to aging and degeneration had been on the rise. Thai hand surgeons have been using several state-of-the-art technologies such as arthroscopic and endoscopic surgery. They are continuing to invent innovations, generating international publications, and frequently being invited as speakers in foreign countries.

Wide-awake local anesthesia for clavicle fracture fixation: A case report.

INTRODUCTION: The wide-awake local anesthesia no tourniquet (WALANT) technique has been used in many orthopedic surgeries. The benefits of this technique are the avoidance of the adverse effects of general anesthesia (GA) and the overall reduction of the cost of surgery. However, a literature search revealed no published report on performing the WALANT technique for clavicular fracture surgery. PRESENTATION OF CASE: We report a case of mid-shaft clavicular fracture that was treated with plate osteosynthesis using the WALANT technique in a patient with uncontrolled atrial fibrillation. During the operation, the patient did not experience any pain, and the procedure could be performed easily due to minimal bleeding in the operative field. The operation was completed successfully without any complications, and the patient was discharged from the hospital the day after surgery. Follow-up radiographs after three months showed union of the clavicle at the fracture site, and the patient could use his arm normally. DISCUSSION: Clavicular fracture is routinely treated with plate osteosynthesis under general anesthesia. In some patients with high morbidity and other risk factors for whom GA is unsuitable, the WALANT technique can prove to be an effective alternative. CONCLUSION: Clavicular fixation can be performed successfully and without any complication under WALANT technique.

Case Report of Customized Distal Radius Prosthesis Replacement: An Alternative Treatment for Post-traumatic Unreconstructable Intraarticular Distal Radius Malunion.

Severely comminuted intraarticular distal radius malunion can significantly affect a patient's quality of life. To date, there is no ideal solution. We propose customized distal radius prosthesis replacement as a treatment option. A 33-year-old policeman presented with left wrist deformity and loss of motion for five months following a distal radius fracture AO (Arbeitsgemeinschaft für Osteosynthesefragen) type-C3 which had been fixed with a volar locking plate incorporate with external fixation and Kirschner wire (K-wire) augmentation for two months. He needed to rely on wrist motion for work. Therefore, we fabricated a customized distal radius prosthesis based on his contralateral normal anatomy to replace the malunion site. The patient was satisfied and able to return to work two months after the operation. Thirty months later, the range of motion had improved from fixed 40° flexion and fixed 70° pronation deformity to 73° flexion, 79° extension, 75° supination, and 85° pronation. His DASH (Disabilities of the Arm, Shoulder, and Hand) score had improved from 80 to 14.2. His pain score, as measured by the visual analog scale, improved from eight preoperatively to two. Unreconstructable intraarticular malunion of the distal radius is a challenging problem with no treatment consensus. Customized distal radius prosthesis may provide a successful treatment option. Future research should elucidate long-term outcomes.

Neuropathy Caused by Metal Hypersensitivity after Placement of Stainless Steel Plate.

Metal hypersensitivity is a rare complication for implants especially with neuropathy involvement. There was not any previous report suggesting metal hypersensitivity manifested in the form of neuropathy or tendinopathy from metal plate implantation. Here, we present a case of a 42-year-old female with chronic ulnar wrist pain and unremarkable physical and radiological findings. Ulna shortening osteotomy with small stainless steel-made DCP and screw fixation was done. On the third day postoperative, the patient developed pain, swelling, ulnar neuropathy, and flexor tendon contracture. Severe adhesion was found around the implant and the ulnar nerve. Minimal skin patch testing reaction and pathological study suggest a cell-mediated delayed type IV hypersensitivity reaction. A titanium-made LCP was later implanted in place of the stainless steel-made DCP. The patient's clinical status significantly improved after the operation. Metal hypersensitivity in this patient was unprecedented and unique. The severity of the reaction and its location close to the ulnar nerve may predispose to the intensity of the reaction.

Distally Based Sartorius Flap to Cover Knee Joint Defect.

INTRODUCTION: The coverage of soft-tissue defects around the knee joint has many reconstructive techniques depending on the size, location, and depth. We report a case with large soft-tissue defect at anterior knee joint that primary closure cannot be done with successfully used distally based sartorius flap and full-thickness skin graft to cover this defect. CASE REPORT: A 30-year-old man had a large skin defect at the knee following a motorcycle accident. The patella tendon and patella were exposed. We use the sartorius muscle flap to cover the wound defect. First, a skin incision was done on the muscle alignment. Then, the sartorius muscle was dissected, and the proximal set of segmental vessels was identified and ligated. Afterward, the sartorius was moved into subcutaneous tunnel and expanded to provide coverage for the wound defect. Finally, we used the full-thickness skin graft to cover over the muscle flap. The flap and graft were survived. The patient could return to work after 1 month after the operation. CONCLUSION: In the case with soft-tissue defects around knee joint, there are many operative techniques. Our case has a large wound at anterior aspect of knee joint. We used the distally based sartorius flap to cover the wound defect. Following the transposition, the sartorius remained viable through out its length, and the patient had full post-operativerecovery.

Intramuscular Hemangioma of the Forearm with Flexion Contracture.

Intramuscular hemangiomas can be an infrequent but important cause of musculoskeletal pain. This report describes a 25-year-old male who presented with pain in the right forearm and contracture of the right hand for 4 years. Physical examination revealed severe tenderness of the midforearm with contracture of the flexor tendons in the index, middle, ring, and little fingers. Conventional radiography of the forearm revealed a soft tissue phlebolith. Magnetic resonance imaging showed a well-defined lobulated mass partially involving the FDP tendon. An intramuscular hemangioma within the deep anterior compartment of the forearm was suspected. Following surgical excision of the hemangioma, the patient's symptoms resolved completely. In conclusion, intramuscular hemangioma can be a rare cause of flexion contracture of the hands and should be considered as a cause of a flexion contracture that fails to respond to conservative treatment.

Outcomes of Endoscopic Carpal Tunnel Release With Ring Finger Flexor Digitorum Superficialis Opponensplasty in Severe Carpal Tunnel Syndrome.

PURPOSE: To evaluate the outcomes of endoscopic CTR with ring finger flexor digitorum superficialis (FDS) opponensplasty for the treatment of patients with severe carpal tunnel syndrome (CTS). METHODS: We prospectively studied 52 patients who were graded as having severe CTS by physical examination and electrodiagnostic studies and who underwent endoscopic CTR-ring finger FDS opponensplasty. Preoperative and postoperative data were collected for active perpendicular thumb abduction; Kapandji score for thumb opposition; grip, key, and tip pinch strength; Medical Research Council score on sensory and motor recovery; Semmes-Weinstein monofilament testing; thenar muscle bulk recovery; and work status. RESULTS: Follow-up was 17.5 months on average (range, 7-34 months). Thumb abduction improved significantly from 13.2° (±4.6°) before surgery to 61.7° (±6.4°) afterward. Mean thumb opposition (as measured by Kapandji score) improved significantly from grade 1.5 to 8.7. Tip pinch strength significantly improved from 38.9% to 72.9% of the contralateral side. Medical Research Council scores improved to S3+ and S4 in 85% of patients and to M4 and M5 in 96% of patients. Sensory threshold recovery to 3.61 and 4.31 monofilament occurred in 85% of patients. We observed thenar muscle bulk recovery in 51.9% of patients. Time to return to work was 5 weeks after surgery, on average. Two patients reported scar pain, 2 reported pillar pain, and we found ring finger proximal interphalangeal joint contracture in 3. CONCLUSIONS: Endoscopic CTR with FDS opponensplasty provides satisfactory outcomes of improved thumb abduction and opposition, sensory and motor recovery, and early return to work in patients with severe CTS. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Effectiveness of hot herbal compress versus topical diclofenac in treating patients with myofascial pain syndrome.

Myofascial pain syndrome (MPS) is a chronic pain disorder which causes musculoskeletal pain and inflammation in the body's soft tissues. Thai Traditional Medicine uses hot herbal compresses as analgesic and anti-inflammatory treatment. There are no scientifically validated follow-up studies after treatment using hot herbal compresses. Effects of hot herbal compresses as an alternative treatment for MPS in the upper trapezius muscle compared with the standard treatment (diclofenac) were examined. Sixty patients with myofascial pain syndrome in the upper trapezius muscle were randomly divided into two groups and assigned to receive either hot herbal compress or nonsteroidal anti-inflammatory drug (diclofenac) treatment for 2 weeks. Clinical assessments included visual analogue scale (VAS) for pain score, cervical range of motion (CROM) for the neck and pressure pain threshold (PPT) tolerability before and after treatment. Within the groups, all treatments caused significant improvement in VAS and marginally increased effectiveness in PPT; however, only hot herbal compress treatment improved CROM. Hot herbal compress was more effective than diclofenac in all tests. Results provided comparable clinical efficacy between hot herbal compress and diclofenac after 2 weeks of treatment. Hot herbal compress proved to be an effective complementary or alternative treatment for MPS in the upper trapezius muscle.

Metacarpal Locked Intramedullary Nail: Surgical Technique and Preliminary Outcome Report.

In surgically indicated metacarpal fractures, the ideal fixation should provide an ample stability for early rehabilitation. Damage to surrounding tissue should be minimized as well, to prevent stiffness which determine the outcomes. We have created the metacarpal locked intramedullary nail (MCLN) that allows immediate motion even in unstable fractures. This preliminary report is objected to demonstrate the surgical technique and outcomes of novel metacarpal fixation. Three surgical indicated metacarpal fractures were treated by MCLN. Unlimited motion was started a day after surgery without external immobilization. Clinical and radiographic control were performed up to two years after the surgery. All of patients returned to previous level of daily activities within six weeks with minimal scar. All fractures were united. The total active motions were above 260° in every patient. Complications were not observed. With this encouraged clinical results, the MCLN could be the promising alternative surgical fixation for metacarpal shaft fractures.

A Comparative of Ginger Extract in Nanostructure Lipid Carrier (NLC) and 1% Diclofenac Gel for Treatment of Knee Osteoarthritis (OA).

Objective: To compare and evaluate the efficacy of ginger (Zingiber officinale Roscoe) extracts in NLC for treatment of osteoarthritis of knee compared to 1% diclofenac gel as an active control. Material and Method: One hundred twenty patients age 50 to 75 years with OA knee, based on the American College of Rheumatology (ACR) criteria were randomized into two groups receiving ginger extracts in NLC and control 1% diclofenac gel for 12 weeks. The efficacy of treatment was monitored at 4, 8, and 12 weeks by using the WOMAC composite index and the Patient Global Assessment (PGA). The t-test was used to compare the mean scores at baseline in each group. Repeated ANOVA was used to compare the mean scores, and Chi-square test was used to compare the dichotomous variables between the two groups at 4, 8, and 12 weeks. Results: One hundred eighteen participants completed the study and were included in the ITT efficacy analysis. Both ginger extract in NLC and diclofenac gel could significantly improve knee pain, stiffness, physical function, and PGA following 12 weeks of treatment. In the repeated ANOVA, there were no differences in the result between these two groups. The response rate for at least a 50% reduction in pain was significantly greater following Ginger extract in NLC treatment compared to topical diclofenac [40/59 (67.7%) vs. 27/59 (45.7%) p<0.05]. There were no significant adverse events. Conclusion: Ginger extract in NLC relieves pain, improves function, and improves the Patient Global Assessment in OA knee during a 12-week treatment.

A novel therapy to promote axonal fusion in human digital nerves.

BACKGROUND: Peripheral nerve injury can have a devastating impact on our military and veteran population. Current strategies for peripheral nerve repair include techniques such as nerve tubes, nerve grafts, tissue matrices, and nerve growth guides to enhance the number of regenerating axons. Even with such advanced techniques, it takes months to regain function. In animal models, polyethylene glycol (PEG) therapy has shown to improve both physiologic and behavioral outcomes after nerve transection by fusion of a portion of the proximal axons to the distal axon stumps. The objective of this study was to show the efficacy of PEG fusion in humans and to retrospectively compare PEG fusion to standard nerve repair. METHODS: Patients with traumatic lacerations involving digital nerves were treated with PEG after standard microsurgical neurorrhaphy. Sensory assessment after injury was performed at 1 week, 2 weeks, 1 month, and 2 months using static two-point discrimination and Semmes-Weinstein monofilament testing. The Medical Research Council Classification (MRCC) for Sensory Recovery Scale was used to evaluate the level of injury. The PEG fusion group was compared to patient-matched controls whose data were retrospectively collected. RESULTS: Four PEG fusions were performed on four nerve transections in two patients. Polyethylene glycol therapy improves functional outcomes and speed of nerve recovery in clinical setting assessed by average MRCC score in week 1 (2.8 vs 1.0, p = 0.03). At 4 weeks, MRCC remained superior in the PEG fusion group (3.8 vs 1.3, p = 0.01). At 8 weeks, there was improvement in both groups with the PEG fusion cohort remaining statistically better (4.0 vs 1.7, p = 0.01). CONCLUSION: Polyethylene glycol fusion is a novel therapy for peripheral nerve repair with proven effectiveness in animal models. Clinical studies are still in early stages but have had encouraging results. Polyethylene glycol fusion is a potential revolutionary therapy in peripheral nerve repair but needs further investigation. LEVEL OF EVIDENCE: Therapeutic study, level IV.

Improving of Knee Osteoarthritic Symptom by the Local Application of Ginger Extract Nanoparticles: A Preliminary Report with Short Term Follow-Up.

OBJECTIVE: An evaluation ofthe efficacy and safety of Ginger (Zingiber officinale Roscoe) extract nanoparticlefor treatment of osteoarthritis (OA) of the knee. MATERIAL AND METHOD: Sixty patients at the age range of 50 to 75 years old who were diagnosed with OA knee based on the American College of Rheumatology (ACR) diagnosis criteria were included in the present study. Participants received ginger extract in Nanostructure Lipid Carrier (NLC) rubbed three times a day for 12 weeks. Efficacy was assessed by Knee Injury and Osteoarthritis Outcome Score (KOOS), Index of Severityfor Osteoarthritis (ISOA), and patient's global assessment (PGA). A series of biochemical tests in serum and hematological parameters were established the safety of ginger extract in NLC. The paired t-test was used to compare the score before and after treatment. The comparisons of baseline and the 4-, 8-, and 12-week used repeated ANOVA. RESULTS: Ginger .extract nanoparticles improved, with statistical significance, the patient's global assessment, knee joint pain, symptoms, daily activities, sports activities, and quality of life measured by KOOS, ISOA, andPGA, following 12 weeks of treatment (p<0.05). There were no safety issues, adverse events, or laboratory values. CONCLUSION: Ginger extract nanoparticles relieves joint pain and improves problematic symptoms and improves the quality of life in osteoarthritis knees during a 12-week treatment.

The Metacarpal Locked Intramedullary Nail: Comparative Biomechanical Evaluation of New Implant Design for Metacarpal Fractures.

BACKGROUND: The optimal fixation of metacarpal fracture should provide sufficient stability to permit early functionfor all types of fracture. However; it must preserve surrounding soft tissue during application and not require secondary removal due to its prominence. The prototype of metacarpal locked intramedullary nail (MCLN) was designed by our institute aiming to achieve those allfeatures. OBJECTIVE: To biomechanically test our newly designed, locked metacarpal nail and compare with common current available fixation methods. MATERIAL AND METHOD: Thirty chicken humeri were devided into 3 groups (n = 1 per group) according tofixation techniques: MCLN, 1.5 mm miniplate (Synthes), and Kirschner wire. After complete fixation, all specimens were osteotomized at mid-shaft creating transverse fractures. Five specimens from each group were tested by load of failure under axial compression, and another five under bending force. RESULTS: In axial compression model, the loads tofailure in MCLN group was greatest (460 ± 17 N), which was significant higher than the Kirschner wire group. The MCLN group also showed the highest load to failure in bending test (341 ± 10 N). This value reaches statistical significance when compared with plate and Kirschner wire groups. CONCLUSION: The MCLN construct provided higher stability than miniplate and Kirschner wire fixation both in axial and bending mode. Together with the minimally invasive and soft tissue-friendly design concept, this study suggests that MCLN is promising fixation option for metacarpal fracture.

Locked intramedullary nail: metacarpal geometry study in adults.

BACKGROUND: Ideal fixation for metacarpal fracture should provide immediate stability to allow early rehabilitation. Locked intramedullary nail may fulfill the need. Metecarpal geometry has to be studied in order to design the locked intramedullaly nail. OBJECTIVE: To study metacarpal geometry in adult cadaver for locked intramedullary nail design. MATERIAL AND METHOD: Radiographs of metacarpals taken from 50 embalmed adult cadavers were measured for essential parameters for locked intramedullary nail design. Total length, proximal metaphyseal width, distal metaphyseal width, isthmus width and medullary canal width were measured. The parameters were analyzed by descriptive statistic. RESULTS: The average total lengths were rangedfrom 44.53 to 65.42 mm. The average metaphyseal widths ofmetacarpal bone were between 11.42 to 16.42 mm. The average medullary canal widths were between 3.05 to 6.74 mm. The extreme small (less than 3 mm) medullary canals were found in index, middle, ring and small metacarpals. CONCLUSION: The results of our study provide crucial preliminary data for locked metacarpal nail design for adult patient.

Acute closed traumatic sciatic nerve injury: a complication of heterotopic ossification and prominence of the femoral nail: a case report.

The report of a 27-years-old man with presence of heterotopic ossification (HO) after femoral nailing 7years ago who developed foot drop afterfalling to the ground on his buttocks. Radiographs revealed a prominence ofthefemoral nail with HO in his right hip. EMG confirmedperoneal nerve injury ofthe hip region. Femoral nail and the HO were removed and external neurolysis was performed. At 9 months after surgery, he had not regain motor power thus posterior tibialis tendon transfer was performed to restore ankle dorsiflexion. Finally, at 2 years follow-up, he could ambulate well but did not regained sensation, extensor digitorum communis and peroneal muscle function.

The comparative study of reliability and reproducibility of distal radius' fracture classification among: AO frykman and Fernandez classification systems.

OBJECTIVE: To study the reliability and reproducibility ofdistal radius fracture classification in plain radiographs. MATERIAL AND METHOD: Ninety-eight displaced distal radius fractures radiographs were classified in four groups ofobservers. The first group consisted of one senior orthopedics staff and two hand-orthopedic surgeons (with experience ranging from ten to thirty years). The first group conducted and evaluated the research altogether This first group was also regarded as standard adjustment. The three other groups comprisedfourth year orthopedics residents, using AO, Frykman, and Fernandez classification systems with six weeks intervals. The results were processed with kappa statistics. The Research to be approached by Thammasat Ethic Committee. RESULTS: The highest kappa coefficient in interobserver agreement was determined in Fernandez classification (0.415), AO classification (0.342), and Frykman classification (0.280). When intraobserver were evaluated, Fernandez classification had a highest mean kappa value (0.343). Then Frykman classification (0.310) and AO classification (0.292) followed. Likewise, the classification, of which each of senior orthopedics residents evaluated most resemble to standard adjustment, was Fernandez classification with a mean of 62.34%. CONCLUSION: Fernandez classification provided satisfactory outcome comparing to standard adjustment and gave a highest inter and intraobserver agreement. Nevertheless, none of the classification systems examined in the present study has achieved an excellent outcome.

The efficacy of Plygersic gel for use in the treatment of osteoarthritis of the knee.

OBJECTIVE: An evaluation of the efficacy of the combination of ginger (Zingiber officinale) and plai (Zingiber cassumunar) gel for the treatment of osteoarthritis of the knee using 1% diclofenac gel as a comparator. MATERIAL AND METHOD: A double-blind, randomized, controlled trial of the combination of 4% ginger and plai extract in a gel (Plygersic gel) as compared with a 1% solution of diclofenac in patients with osteoarthritis knees. The number of participants in each group totaled fifty. The length of treatment was a 6 week period. The efficacy of the drugs was monitored by using the Knee Injury and Osteoarthritis Outcome Score (KOOS). The t-test was used to compare the scores before and after treatments in each group. The repeated ANOVA was used to compare the scores between the two groups. RESULTS: Both Plygersic gel and diclofenac gel could significantly improve knee joint pain, symptoms, daily activities, sports activities and quality of life measured by KOOS following 6 weeks of treatment. In the repeated ANOVA, there were no differences in the results between the Plygersic and diclofenac gel groups. CONCLUSION: Plygersic gel relieves joint pain and improves problematic symptoms and improves the quality of life in osteoarthritis knees during a 6 week treatment regimen with no differences to the 1% Diclofenac gel group.