Closed treatment of humeral shaft fractures by functional bracing using polyvinyl chloride versus plaster-of-paris cast: A randomized clinical trial

INTRODUCTION@#This study compared Polyvinyl Chloride (PVC) made vs Plaster of Paris (POP) made functional braces in the closed treatment of fractures of the humeral shaft. Outcomes examined were the rate of fracture union, radiographic alignment, DASH scores and the range of motion of the shoulder and elbow@*METHODS@#This was a parallel randomized clinical trial conducted at the Corazon Locsin-Montelibano Memorial Regional Hospital from July 2016 to July 2017. All eligible patients were included and randomly allocated into PVC and POP treatment groups. All patients were followed-up on the 3rd, 6th, 10th, and 14th week for clinical and radiographic evaluation.@*RESULTS@#There were 31 patients, 14 and 17 in the PVC and POP groups, respectively. The median rate of union in the PVC and POP groups were 10.50 and 10.00 weeks, respectively. The median varus and valgus angulation in the PVC and POP groups were 15.75° and 16.5°, respectively. The median anterior and posterior alignment in the PVC group was 1.7° and POP group was 9.6°. The median DASH score of the PVC and POP groups were 7.1 and 12.5, respectively. The median range of motion in the elbow was 135° for both groups. The median range of motion in the shoulder in the PVC group was 150° and POP group was 140°.@*CONCLUSION@#There was a high rate of union of humeral shaft fractures with acceptable functional outcome with the use of the PVC made functional brace compared to the traditional POP made functional brace.

Efficacy and cost of negative pressure wound therapy (NPWT) dressing versus tie-over bolster dressing on integrating split-thickness skin grafts

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> This study aimed to compare two dressing methods used as skin graft bolsters. The two dressings were compared as to efficacy (% graft take), ease of application, pain scores, safety(complication rate) and cost.</p><p style="text-align: justify;"><strong>METHODS:</strong> This is a prospective randomized controlled trial involving 34 patients. The basis of comparison between the two dressing methods included: efficacy determined by percentage of graft take on the 7th and 14th day post-Split Thickness Skin Grafting; ease of the application (amount of time to apply dressing); pain (VAS) scores at 1st, 7th and 14th day post-Split Thickness Skin Grafting; complications and costs.</p><p style="text-align: justify;"><strong>RESULTS:</strong> The NPWT group has statistically significant differences from the Tie-Over Bolster group. NPWT took less time to apply the dressing (1-10mins vs 6-15mins), had a higher percentage of graft take (99.05% vs 96.52%), had lower pain scores overall, had lower complication rates (infection: 0% vs 2.94%), and cost less (Php 2,917.00 vs Php 3,684.00).</p><p style="text-align: justify;"><strong>DISCUSSION:</strong> The Low-Cost NPWT system was developed in this institution due to the exorbitant cost of commercial NPWT pump and dressing systems. Thus, a week-long NPWT therapy using commercial NPWT systems may cost as much as Php 24,000.00, while the low-cost NPWT alternative only costs Php2,917.00.</p><p style="text-align: justify;"><strong>CONCLUSIONS:</strong> The locally-developed, low-cost NPWT dressing has been proven to be faster to apply, more effective in integrating split-thickness skin grafts, has less discomfort and complications, and is actually cheaper than the conventional tie-over bolster dressings.</p><p style="text-align: justify;"> </p>