Effectiveness of prolotherapy in the treatment of chronic rotator cuff lesions.

BACKGROUND: Rotator cuff lesions are one of the major causes of shoulder pain and dysfunction. Numerous non-surgical treatment modalities have been described for chronic rotator cuff lesions, but the debate continues over the optimal procedure. The aim of this report is to present the results of prolotherapy in the treatment of chronic refractory rotator cuff lesions. HYPOTHESIS: Dextrose prolotherapy will reduce pain and improve shoulder function and patient satisfaction. MATERIAL AND METHODS: We recruited 120 patients with chronic rotator cuff lesions and symptoms that persisted for longer than 6 months. Patients were divided into two groups: one treated with exercise (control group; n=60) and the other treated with prolotherapy injection (prolotherapy group; n=60). In the latter, ultrasound-guided prolotherapy injections were applied under aseptic conditions. In the former, patients received a physiotherapy protocol three sessions weekly for 12 weeks. Both groups were instructed to carry out a home exercise program. Clinical assessment of shoulder function was performed using a visual analog scale (VAS) for pain, Shoulder Pain and Disability Index (SPADI), Western Ontario Rotatory Cuff (WORC) Index, patient satisfaction, and shoulder range of motion. Patients were examined at baseline, weeks 3, 6, and 12, and last follow-up (minimum of one year). RESULTS: A total of 101 patients (44 controls and 57 in the prolotherapy group) completed all study protocols and were included in the study. Using a within-group comparison, both groups achieved significant improvements over baseline, as measured by the VAS, SPADI, WORC index, and shoulder range of motion (P<0.001). Using a between-group comparison, a significant difference was found in the VAS scores at baseline, weeks 3, 6, and 12, and last follow-up. In addition, significant differences were found in the SPADIs and WORC indices at weeks 6 and 12 and the last follow-up. Significant differences were found in shoulder abduction and flexion at week 12 and last follow-up, and in internal rotation at last follow-up. However, no significant was found in external rotation at any follow-up period. In the prolotherapy group, 53 patients (92.9%) reported excellent or good outcomes; in the control group, 25 patients (56.8%) reported excellent or good outcomes. CONCLUSION: Prolotherapy is an easily applicable and satisfying auxiliary method in the treatment of chronic rotatory cuff lesions. STUDY TYPE: Randomized prospective comparative trial. LEVEL OF EVIDENCE: Level of evidence 1.

Pedobarographic measurements after repair of Achilles tendon by minimal invasive surgery.

The aim of the current study was to assess the changes of plantar foot pressures with pedobarography in -patients with Achilles tendon repair by minimally -invasive surgical technique. This retrospective study consisted of 15 consecutive patients who were treated for acute Achilles' tendon repair with minimally invasive technique in our clinic in a two year period between 2010 and 2012. All patients were male. The mean age was 28.7 years (24-42) and the mean follow-up time was 2.3 years (1.5- 3). All patients had sports related Achilles' tendon rupture and all had undergone surgery in 24-48 hours. After surgery, extremity was immobilized with short leg cast for 6 weeks. Peak and mean heel and forefoot pressures in injured extremity were measured by -pedobarograph and compared with noninvolved foot. There wasn't any complication associated with -surgery such as wound problems, re rupture or -neurologic injury. Only three patients had some numbness at the incision site. When we compare the mean foot pressures between the operated foot and the normal foot, there was no statistical difference about peak and mean heel and forefoot plantar pressure between involved site and non involved site. As a result, Achilles tendon repair with minimal invasive technique and early rehabilitation may prevent changes of plantar foot pressure distribution.

Difference between Spinecor brace and Thoracolumbosacral orthosis for deformity correction and quality of life in adolescent idiopathic scoliosis.

Although there are several conservative treatment options, only bracing has been found to be effective in preventing curve progression and a subsequent need for surgery in adolescent idiopathic scoliosis. The objective of this study is to compare the results of SpineCor brace and thoracolumbosacral orthosis (TLSO) for treatment of adolescent idiopathic scoliosis radiologically and clinically. Sixty-four patients with adolescent idiopathic scoliosis treated with brace included in this study. Height, T1-Coccygx distance, and gibbosity were measured. Rib hump deformity was evaluated with a scoliometer. An SRS-22 questionnaire was used to determine the quality of life of patients after the first year of brace treatment. Differences in Cobb angles and gibbosity were insignificant for both groups. SRS-22 questionnaire results showed significant differences in pain, self-image and function/activity subgroups. Patients' mental health and satisfaction scores were insignificant. These braces have a similar effect on deformity correction. The surgery rates and success rates of braces are approximately equal. The major difference between SpineCor and TLSO is health-related quality of life.

Spiral-medial butterfly fractures (AO-12-B1) in distal diaphysis of humerus with rotational forces: preliminary results of open reduction and plate-screw fixation.

OBJECTIVE: Humerus shaft fractures are frequent injuries in orthopedic practice and generally occurs with direct and indirect traumas. While the most of these fractures can be managed with conservative methods, in some situations surgery is needed. The aim of this study is to define a different mechanism and treatment result of  humerus spiral fractures with medial butterfly fragment (AO-12-B1). PATIENTS AND METHODS: Between 2010 and 2013, 11 patients who had undergone surgery for spiral humerus shaft fracture with medial large butterfly fragment (AO type 12-B1) resulting from a motor vehicle accident were enrolled to the study. All data was retrieved from the hospital's database retrospectively. All fractures were closed type and all of the patients were treated with open reduction and plate osteosynthesis through lateral approach. Elbow and shoulder ROMs were examined for functional outcomes. The DASH (Disabilities of the Arm, Shoulder and Hand) scoring system was applied at the final follow-up visit. RESULTS: There were 7 male and 4 female patients with a mean age of 36 years (range, 28-50 years). All of the fractures occurred with same mechanism resulting from motor vehicle accident. Conservative treatment was not considered for any of the cases. The mean time to surgery was 2 days (1-3 days). The mean postoperative follow-up period was 14 months (6-24 months). All fractures had healed completely at 3 months postoperatively. At the final follow-up visit the mean DASH score was 4.2 (3.3-6.7). CONCLUSIONS: Humerus spiral shaft fractures with a large medial butterfly fragment can be seen in dashboard injuries. It is important to fix the medial large fragment anatomically and minimal invasively in order to achieve union and not to disturb the vascular supply.

Obligatory occupational health check increases vaccination rates among medical students.

In October 2002 an obligatory occupational health check for all preclinical students at the University of Erlangen-Nuremberg was introduced. Over the period 2005 to 2007, medical students started their clinical year either with or without a health check during their preclinical years. The aim of the study was to evaluate the efficacy of health checks for preclinical students with respect to vaccination rates. At the beginning of the clinical year we examined 242 consecutive students, 121 with and 121 without a preceding preclinical occupational health check. The immunisation rate against hepatitis B increased during medical education from 50% to 96% in women and from 58% to 96% in men. In medical students without an initial occupational health check, vaccination rates were significantly lower (85% in women and 81% in men). A significant benefit from the preclinical check was seen in men regarding immunisation status for hepatitis B, tetanus, diphtheria, polio, rubella and mumps and in women for hepatitis B and rubella. This study demonstrates that it is possible to significantly increase vaccination rates, particularly for men. Even in medical students starting their clinical training, an individual occupational health check is necessary to optimise immunisation against infectious diseases. Routine occupational health checks could make an important contribution to closing gaps in vaccination coverage.