1,721,618 research outputs found
A contemporary view of platelet-rich plasma therapies: Moving toward refined clinical protocols and precise indications
No full textThe positive extensive clinical experience with platelet-rich plasma (PRP) in different medical areas has prompted researchers to explore clinical opportunities for optimized PRP therapies. PRP is safe but we have to make it more effective. The growing diversity of formulations and presentations enrich the field of PRP research and offer hope to refine clinical indications. Moving toward targeting the right disease phenotypes with the right PRP formulation or combination product (PRP+cell products) can offer opportunities to change treatment options in osteoarthritis and nonhealing wounds. Both are active areas of research that could offer opportunities, although cost efficacy is still an open question. Our position is to believe that these serious disease areas are likely to benefit from PRP therapies
Letter Regarding: Endoscopic Flexor Hallucis Longus Transfer for Chronic Noninsertional Achilles Tendon Rupture
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Clinical and radiographic outcomes after minimally invasive locking plating of distal tibia fractures.
No full textObjective: Assess the bone union rate, deformity, leg-length discrepancy, return to pre-injury daily and sports activities and infection rate in a selected group of 21 patients who underwent minimally invasive osteosynthesis of close distal tibia fractures with Locking plate (LP).
Material and methods: We prospectively included patients with closed distal tibia and fibula fractures, without any previous or present ipsilateral leg fracture. There were 9 women and 12 men, ranging in age from 25 to 66 yrs. Fractures were classified according to AO classification. There were 12 type A, 5 B, and 4 C fractures. Clinical, functional, and radiographic evaluations were scheduled at 6, 12, 24 weeks, 1 year, and then annually. Results were classified in accordance to criteria developed by the Association for the Study and Application of the Method of Ilizarov (ASAMI). The results were divided into bone and functional results. For bone results four criteria were evaluated: union time, infection, deformity (< 7°), and leg-length discrepancy (< 2.5 cm) at standard long-leg radiographs. The functional results were based on five criteria: limp, equinus rigidity of the ankle, soft-tissue dystrophy, pain, and inactivity (unemployment because of the leg injury or inability to return to daily activities because of the leg injury).
Results: The average follow-up was 2.8 years (range, 2 to 4). Two patients were lost to follow-up. Union was achieved in all but one patient. Four patients had angular deformity < 7°. No patient had a leg-length discrepancy ≥ 1.1 cm. Five patients had range of motion of ankle ≤ 20° compared with the contralateral side. Sixteen patients had not returned to their preinjury sporting or leisure activities. Three patients developed a delayed infection. According to the ASAMI criteria, there were 15 excellent, 3 good and 1 poor “bone results” and 11 excellent, 3 good and 5 fair “functional results”.
Conclusions: The high percentage of unions and the low rate of complications show that LP is a suitable device for treatment of distal tibia fractures. The level of physical activities appears permanently reduced in most of patients. The cost of the LP, the technically demanding procedure, and the increased exposure to radiation to perform the procedure should be considered when comparing the efficacy of this device to the normal plates. Only future prospective randomized studies may be able to clarify these issues
Balloon tibioplasty for tibial plateau fractures
No full textBackground: Tibial plateau fractures are complex intra-articular injuries. The aim of treatment is to restore joint congruity and alignment. Balloon tibioplasty is a novel, minimally invasive technique to reduce the fracture and restore the continuity of the articular surface. A systematic review was performed according to the PRISMA guidelines in order to assess the outcomes from this procedure. Sources of data: The online databases of Pubmed, Google scholar, the Cochrane Library, EMBASE and CINAHL were searched. Articles of interest were retrieved and evaluated, including case series, randomised controlled trials and cadaver studies. Areas of agreement: Eight studies (one randomised controlled trial, four case series and three cadaver studies) were included in the final review. The studies demonstrated adequate fracture reduction with favourable clinical and imaging outcomes from balloon tibioplasty. Very few complications were described. Areas of controversy: There is a small volume of literature currently available on balloon tibioplasty with an overall low level of evidence. The overall number of reported cases is also small. Growing points: Further research is necessary, with adequately powered randomised controlled trials. Further areas of research include type of bone substitute and the use of arthroscopically assisted surgery
Letter to the Editor “Management of the first-time lateral patellar dislocation. [The Knee 26 (2019) 1161–1165]”
No full textReply Letter to the Editor on: "Return to sport following Lisfranc injuries: A systematic review and meta-analysis"
No full textKarate white belt finger
No full textDear Editor-in-chief
Traditional Shotokan Karate training requires hand conditioning using the Okinawan traditional padded punching board, the “makiwara ”(maki -“roll up ”or “wrap”, and wara- to “straw”). Karate practitioners used to work out for hours with this device, to toughen the hands and strengthen the wrists to be able to deliver more powerful hand techniques. However, even though they may not use a makiwara, modern karatekas practice their karate strikes on sandbags. This training may produce different injuries (Adams and Mutasim, 2001; Vayssairat et al., 1984). Crosby (Crosby, 1985) radiographed the hands and wrists of 22 karate instructors, 17 of whom punched regularly the makiwara and performed pushups on the knuckles every day. He concluded that zealous use of the makiwara was a cause of pain and stiffness in the hands and wrists, but neither practice had a consistently deleterious effect on the mobility of the index and middle fingers metacarpo- phalangeal joints which bore the brunt of the impact.
“Karate Kid finger ”(Chiu, 1993) is a traumatic condition of the little finger occurring in karate participants. It may become clinically evident as pain and paraesthesiae along the ulnar border of the little finger and hand. The ulnar dorsal digital nerve of the little finger can be damaged by repetitive contusion when the hand performs karate chop called “tsuki”. The repetitive impact may cause fibrosis within the nerve sheaths and between the nerve fibres. The “Karate Kid finger ”is managed surgically by neurolysis. Overuse and poor technique are considered risk factors. Gichin Funakoshi, the father of modern karate, in the book Karate Jitsu (Funakoshi, 2001), decribes the correct way of performing the karate chop “tsuki”. Precisely, he pointed out that the “seiken ”(the traditional karate “tsuki”) has four point of contact: the first two knuckles and the proximal interphalangeal joint of the index and middle finger. Even though Funaskoshi recommended to practice on makiwara, he was aware of the risks which can be carried out by an uncontrolled and excessive training. Infact, he also wrote: “Then there are those who, having a superficial knowledge of one or two karate techniques, hold their fists in such a way as to call attention to their callused knuckles while pushing their way through crowds as if looking for a fight - foolish beyond words”(Funakoshi, 1995). As proper technique to perform the karate “tsuki ”requires impact to be driven on the first two knuckles and the proximal interphalangeal joint of the index and middle finger, the forearm pronated and the wrist slightly ulnar deviated. The causative factor of the “Karate Kid finger ”is poor technique. The ulnar dorsal digital nerve of the little finger can be damaged only if the “tsuki ”is performed as usually the lower level karatekas (white belt) do, namely with the knuckles of the middle, ring, and little finger as the points of impact. Hence, we suggest that this condition should be more aptly named “karate white belt finger”
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