ABSTRACT
Platelet-rich plasma (PRP) is a fraction of whole blood containing powerful growth factors and cytokines. Preclinical studies suggest PRP may be useful for tendon repair or regeneration. Clinical investigations have focused on the treatment of chronic lateral epicondylar tendinopathy and rotator cuff pathology. Multiple controlled studies support the use of PRP for chronic tennis elbow. Rotator cuff studies, however, have produced conflicting results based on PRP formulation, surgical technique, and size of tendon tear. This article explores the scientific rational for using PRP, its various formulations, and the emerging clinical data. Future potential applications are also explored.
Subject(s)
Platelet-Rich Plasma , Tennis Elbow/therapy , Humans , Platelet-Rich Plasma/chemistry , Platelet-Rich Plasma/physiology , Rotator Cuff Injuries , Rupture , Tendon Injuries/therapy , Wound Healing/physiologyABSTRACT
Treatment of segmental tibial bone defects after high-energy trauma or atrophic nonunion resection is challenging. In the last two decades, distraction osteogenesis Ilizarov bone transport has become a gold standard for the treatment of segmental tibial bone defects and lengthening in spite of the fact that frequent frame modifications and the need for sequential correction of deformities during bone transport are the main limitations of the device itself. The Taylor Spatial Frame applies the concept of the Stewart platform to the standard Ilizarov frame while applying the same principles of distraction osteogenesis postulated by Ilizarov. We report the case of a patient with two problems we could treat simultaneously: an ankle equinus contracture (a consequence of limb leg discrepancy) and infected tibial nonunion and soft-tissue damage complication after plating in a 41A3 type II Gustilo fracture of the left leg.
Subject(s)
External Fixators , Fracture Fixation, Internal/methods , Fractures, Ununited/surgery , Ilizarov Technique , Multiple Trauma/surgery , Tibial Fractures/surgery , Accidents, Traffic , Adult , Anti-Bacterial Agents/therapeutic use , Debridement , Drainage , Equinus Deformity/complications , Equinus Deformity/surgery , Fractures, Ununited/diagnosis , Fractures, Ununited/drug therapy , Fractures, Ununited/etiology , Fractures, Ununited/microbiology , Humans , Ilizarov Technique/instrumentation , Injury Severity Score , Male , Motorcycles , Multiple Trauma/diagnosis , Multiple Trauma/drug therapy , Multiple Trauma/etiology , Recovery of Function , Risk Assessment , Sciatic Nerve/injuries , Staphylococcal Infections/complications , Staphylococcus aureus/isolation & purification , Tibial Fractures/diagnosis , Tibial Fractures/drug therapy , Tibial Fractures/etiology , Treatment OutcomeABSTRACT
OBJECTIVE: To assess and compare the results of trifocal (two-level bone lengthening with compression at the nonunion site) and bifocal (one-level bone lengthening with compression at the nonunion site) bone transport using the Taylor Spatial Frame (TSF; Smith and Nephew, Inc, Memphis, TN) for postinfectious segmental tibial bone defects. DESIGN: Retrospective study of 12 patients with atrophic tibial nonunions. These patients were treated with resection of the nonunion followed by bone transport using the TSF for the segmental tibial bone defects. All patients were treated by the same surgeon (F.S.). SETTING: Level I trauma center. PATIENTS/PARTICIPANTS: Twelve consecutive patients treated for postinfectious segmental tibial bone defects between November 2004 and September 2007. INTERVENTION: All patients were treated using the TSF for a trifocal or bifocal technique of bone transport along with associated soft tissue reconstructive surgeries. All patients were additionally treated with 45 days of culture-specific antibiotics. OUTCOME MEASUREMENT: All patients were evaluated by the guidelines of the Association for the Study of the Method of Ilizarov. RESULTS AND CONCLUSION: All patients achieved complete union and eradication of infection. The results were evaluated according to Association for the Study of the Method of Ilizarov criteria: 83% were excellent and 17% were good in terms of bony outcomes; functional results were excellent in 50%, good in 42%, and fair in 8%. Combined Ilizarov/TSF trifocal and bifocal techniques for the treatment of segmental tibial bone defects achieve union without malalignment of the mechanical axis.
Subject(s)
External Fixators , Fractures, Malunited/surgery , Ilizarov Technique/instrumentation , Osteotomy/methods , Surgical Wound Infection/surgery , Adult , Aged , Equipment Design , Female , Humans , Male , Middle Aged , Retrospective Studies , Tibia , Treatment Outcome , Young AdultABSTRACT
The timing of definitive fixation for major fractures in polytrauma patients is controversial. We investigated the outcome of the Sheffield hybrid system (SHF) as a solution in the role of primary and definitive fixator for patient with open femoral fractures in whom definitive osteosynthesis with intramedullary nail can be associated with higher rate of complications. Eleven patients (7 men and 4 women), mean age of 40.4 years (range 14-75 years) with previous injury severity score (ISS) greater than or equal to 16 were treated from a damage control orthopedics perspective. Time in the fixator averaged 28 weeks (range 10-64 weeks). Mean follow-up was 3 years (2-4.5). All fractures united. Paley functional and bone results in most cases were good to excellent. Final mean knee range of motion was 113 degrees. We found that SHF for complex fractures of the femur combine maximum support for the bone and preservation of soft tissues. SHF is an effective technique compared to internal nails and earlier external fixator devices, attributable to its advantages such as continuity of frame till union, preventing any second-hit phenomenon, early mobilization, and restoration of primary defect due to bone loss by differential distraction osteogenesis without additional surgery.
