Rashid Anjum

Abstract

Introduction: The present management line of osteoarthritis of knee is mostly symptomatic, therefore the need to investigate treatment modality which addresses the disease process in itself. This study was undertaken with an aim to evaluate the efficacy of platelet rich plasma in primary osteoarthritis of knee. Materials and Methods: This prospective study was done on 67 knees in 60 patients of early primary osteoarthritis of the knee. Three injections of platelet rich plasma were given at four weeks interval and the outcome was evaluated using WOMAC and VAS score at pre injection, 3 weeks, 12 weeks and 24 weeks. Ahlback’s grading was done at pre-injection and at 6 months. Results: Most of the cases in our series were in the age group of 51-60 years with female predominance (66.7%), 46 cases had grade 2 disease and the remaining had grade 1 involvement. Improvement in WOMAC score parameters started at 3 weeks with progressive improvement at subsequent follow-ups. WOMAC score parameters (pain, stiffness, physical function and total score) at pre injection were 14.31, 5.01, 36.52 and 55.75 and at 6 months follow up were 6.54, 2.03, 19.07 and 27.66 respectively. Similar improvement was seen in VAS score with pre injection score of 6.45 and final score of 3.76. The average WOMAC score was less for grade 1 as compared to grade 2 (45.52 and 60.41). Improvement was seen in 89.55% of cases though the level varied from good to mild improvement. There was no complication related to the treatment in our series. Conclusion: The initial results conclude that PRP is an effective treatment modality in early grades of primary Osteoarthritis of knee. However, further high evidence studies are required to look for the long-term effects and to confirm the findings of this study. Keywords: Platelet rich plasma, osteoarthritis, intra articular injection, PRP in knee.

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Abstract

Introduction: Intramedullary (IM) nailing is considered the method of choice for treatment of closed diaphyseal fractures of the tibia. However, there is controversy in the literature regarding the best way of managing open type III B fractures. The aim of this study was to evaluate the effectiveness of unilateral external fixator as primary and definitive treatment for Gustilo and Anderson compound grade III B open tibial fractures. Materials and Methods: This was a retrospective case series of patients with Gustilo and Anderson compound grade III B open tibial fractures treated in our institution from Jan 2010 to May 2014. All the cases that were treated with unilateral tubular external fixators within 24 hours of injury were included. Serial debridement and early coverage if required, was done within seven days. Dynamisation and partial weight bearing was started at 8-10 weeks on observing early signs of fracture healing. Weight bearing with patellar tendon bearing cast was permitted at 12–16 weeks, on visualization of bridging callus and continued till radiological and clinical union. Results: There were 31 males (83.7%) & 6 females (16.2%) with Gustilo IIIB fractures with a mean age of 37.43± 8.92 years and a standard error of 0.55. The commonest mode of trauma was road traffic accidents followed by fall from height & direct trauma to the limb. All the patients were operated in emergency within 24 hours with debridement of wound and primary external fixation. The average time to union was 22.13 ±2.68, superficial pin track infection occurred in 11 cases & deep infection leading to loosening of Schanz screw was seen in two patients. Delayed union was seen in two patients whereas, non-union was seen in three patients requiring secondary procedures. Conclusion: The results show that unilateral external fixators can be used as primary and definitive treatment for compound type IIIB tibial shaft fractures with satisfactory outcomes. These are particularly helpful in resource limited setups, where the operating surgeons may not have a wide range of implants and instrumentation at their disposal owing to low financial profile of patients. Keywords: External fixation, Definitive treatment, Open tibial fractures, Gustilo Anderson type IIIB.

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