Visual Analogue Score Score Research Articles

Autologous platelet-rich plasma in the delayed union of long bone fractures – A quasi experimental study

IntroductionFractures of long bones unite without any complication except for 2%–10% which may lead to delayed or non-union of the fracture. Management of delayed union of fractures poses a great challenge for orthopaedic surgeons. Platelet-rich plasma (PRP) is an autologous blood-derived biological agent, which delivers growth factors, cytokines, and bio-micro molecules at supraphysiologic concentrations at the site of tissue injury, thus potentiating the body's healing efforts. Various studies and research have proved the osteogenic activity of PRP. The growth factors present in the PRP induce the locally available resilient progenitor or stem cells and convert the atrophic environment into a trophic environment. Materials and methodsWe investigated the safety and efficacy of autologous PRP injection in the delayed union of long bone fractures. A total of 25 cases of delayed union of long bone fractures were augmented with 3 doses of autologous PRP at 3 weekly intervals and were followed up for 12 months. All the cases were documented with pre-and post-procedural and 12th -month visual analog score (VAS) and Warden's score. ResultsOut of 25 cases, 21 (84.00%) cases showed good union of fracture with adequate callus formation by 10–12 weeks with 3 doses of autologous PRP injections. The mean pre-procedural VAS and Warden's score at the final follow-up showed statistically significant results (p < 0.05). No other complications were noted due to autologous PRP application among the study participants during the study period except for 3 cases (2 cases of non-union, and 1 case of implant failure). ConclusionResults of the current study suggest that autologous injection of PRP might be a safe and effective therapeutic tool for the management of delayed union of long bone fractures.

Effects of Preoperative Sleep Disorders on Anesthesia Recovery and Postoperative Pain in Patients Undergoing Laparoscopic Gynecological Surgery under General Anesthesia.

Sleep disorder dramatically affects people's physical and mental health. Here, we investigated the effect of preoperative sleep disorders on anesthesia recovery and postoperative pain in patients undergoing laparoscopic gynecological surgery under general anesthesia. 120 patients who underwent elective laparoscopic gynecological surgery under general anesthesia in Taizhou Central Hospital from November 2021 to March 2022 were included. According to the score of the Pittsburgh sleep quality index (PSQI), the participating patients were divided into four groups: control group (control group), mild sleep disorder group A (group A), moderate sleep disorder group B (group B), and severe sleep disorder group C (group C), with 30 patients in each group. The changes of mean arterial pressure (MAP) and heart rate (HR) at different time points, operation time, anesthesia time, extubation time, the time when Aldrete score reached 10 points, visual analog score (VAS) serum interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor-α (TNF-α) were compared among different groups. Our study demonstrated that there were no significant differences in MAP and HR among the four groups at the same time points (all P > 0.05). Significant differences in the time of extubation and Aldrete score reaching 10 points had been found among the four groups (all P < 0.001), indicating more sleep disorder induced longer extubation and recovery time. There were significant differences in VAS scores among the four groups at both different and the same time points (all P < 0.001), suggesting more sleep disorders induced more pain in the sufferers. Serum IL-6 levels were significantly higher in the three sleep disorder groups than the control group at 6 h and 24 h after the operation (all P < 0.05), while group C has the highest IL-6 levels as compared to the other group (P = 0.09 and P < 0.001, respectively). At 6 h after operation, serum levels of TNF-α in group C were significantly higher than in the control group (P = 0.044), but no significant differences were found in the other two groups (all P > 0.05). Positive correlation with preoperative PSQI score has been found with the times of extubation, the time of Aldrete score reaching 10 points, the VAS at 1 h, 6 h, and 24 h after operation, the level of serum IL-6 at 1 day before operation and 6 h and 24 h after operation, and the TNF-α at 6 h and 24 h after operation (all P < 0.001). The present study showed that the degree of preoperative sleep disorders could affect the quality of postoperative awakening and pain of patients undergoing laparoscopic gynecological surgery under general anesthesia, which might be associated with the aggravation of inflammatory reactions in the body.

Preoperative anxiety on postoperative pain in craniotomy patients

Aim: This study aimed to determine preoperative anxiety and pain levels in patients who underwent craniotomy and investigate the effects on the development of postoperative acute-chronic pain. Materials and Methods: In this prospective, observational study, STAI-I (State-Trait Anxiety Inventory) and STAI-II were used to measure preoperative anxiety levels in a total of 104 patients who underwent craniotomy, and a visual analog score (VAS) was used to determine pain. Demographic data of the patients, ASA (American Society of Anesthesiologists) scores, comorbidities, preoperative and postoperative VAS scores, cause of preoperative anxiety, type, and duration of operation were recorded. Results: The mean values of STAI tests showed that 31.3% of our patients had mild preoperative anxiety, 58.7% had moderate and 10% had severe preoperative anxiety. In the STAI tests we performed before the operation, the mean values were 44 ± 11.2 for STAI-I and 44.5 ± 9.4 for STAI-II. The causes of preoperative anxiety in patients were determined as surgical operation (35.6%), anesthesia applications (17.3%), insufficient information (11.5%), and the possibility of postoperative pain (3.8%). It was observed that 60.6% of our patients had pain in the preoperative period, 51.9% of patients had acute pain in postoperative the 0th minute, 69.2% in 30th minute, 54.8% in 1st hour, 44.2% in 2nd hour, 34.6% in 24th hour, 22.1% in 48th hour, and 51% of patients had chronic pain in postoperative 6th month. We found a significant relationship between STAI-I and VAS scores at the 48th hour and, between STAI-II and VAS scores at the 2nd, 24th hour, and 6th month (p&amp;lt;0.05). Conclusion: It was observed that craniotomy patients mostly had moderate anxiety and moderate to severe pain before the operation, and moderate-severe acute and chronic pain developed after the operation. A significant correlation was found between preoperative anxiety and postoperative pain.

Ultrasonic Osteotome Assisted Posterior Endoscopic Cervical Foraminotomy in the Treatment of Cervical Spondylotic Radiculopathy Due to Osseous Foraminal Stenosis.

To investigate the efficacy and safety of the posterior endoscopic cervical foraminotomy (PECF) using ultrasonic osteotome for the treatment of cervical osseous foraminal stenosis，focusing on introduction of the advantages of ultrasonic osteotome in partial pediculectomy and ventral osteophyte resection in PECF. Nineteen patients with cervical osseous foraminal stenosis who underwent PECF using ultrasonic osteotome in our institution between April 2018 and April 2021 were enrolled in this study. All the patients were followed up more than 12 months. The patients' medical data, as well as pre- and postoperative radiologic findings were thoroughly investigated. The visual analogue score (VAS), Japanese Orthopaedic Association (JOA) score, cervical dysfunction index (Neck disability index, NDI), and modified MacNab criteria were used to assess the surgical efficacy. All the patients were successfully treated with PECF using ultrasonic osteotome. The pre- and postoperative VAS, NDI, and JOA scores were significantly improved (p<0.05). According to the modified MacNab criteria, 17 patients were assessed as "excellent", two patients were assessed as "good" at the last follow-up. There was no dura tear, nerve root damage, incision infection, neck deformity, or other complications. Adequate nerve root decompression can be accomplished successfully with the help of ultrasonic osteotome in PECF, which has the advantage of reducing the probability of damage to the nerve root and dura mater, in addition to the original merits of endoscopic surgery.

Application of Comfort Therapy under eCASH Concept in Acute and Chronic Wound Treatment.

Given the new ideas on wound care offered by the eCASH (early Comfort using Analgesia, minimal Sedatives, and maximal Humane care) and the substantial differences in clinical treatment between acute and chronic wounds, we aimed to investigate the effect of comfort therapy under the eCASH concept on analgesic sedation and accelerated wound healing in patients with acute or chronic wounds. This randomized clinical study was conducted in two parts: acute wounds and chronic wounds. Patients with acute wounds were allocated into the acute wound control group (AWCG) and the acute wound experimental group (AWEG). Patients with chronic wounds were allocated into the chronic wound control group (CWCG) and two experimental groups, in which they received intermittent negative pressure therapy (IPTEG) and continuous negative pressure therapy (CPTEG). On the basis of the standard treatment for patients in the control group, eCASH therapy was used in the experimental groups. In addition, pain intensity and procedural anxiety were evaluated using the visual analogue score (VAS) and the Hamilton Anxiety Scale (HAM-A). In addition, clinical effects were assessed on the basis of the size of the surface area, rate of healing, and concentration of pro-inflammatory factors (IL-1, IL-6, TNF-α) and growth factors (VEGF, bFGF, TGF-β1). Compared with the control group, the VAS score and HAM-A score in the experimental groups were significantly decreased after intervention (P < 0.05). After intervention, the levels of IL-1β, IL-6, and TNF-α in AWEG, IPTEG, and CPTEG were significantly lower than those in AWCG. In addition, the levels of VEGF, bFGF, and TGF-β1 in IPTEG and CPTEG were significantly higher than those in CWCG (P < 0.05). These results indicated that comfort therapy under the eCASH concept has a significant effect on ameliorating the pain and anxiety of patients, reducing the inflammatory reaction during the period of wound healing in the treatment of acute and chronic wounds. The trial has been registered in the Chinese Clinical Trial Registry (ChiCTR2200057981).

Transforaminal Endoscopic Lumbar Discectomy versus Open Decompression Discectomy for Lumbar Disc Herniation.

To compare the efficacy of transforaminal endoscopic lumbar discectomy (TELD) and open decompression discectomy (ODD) in the treatment of single-segment L4/5disc herniation. Descriptive study. Department of Orthopedics, General Hospital of the Yangtze River Shipping, Jiang'an District, Wuhan, Hubei, China, from January to December 2021. Using random number table allocation, 94 patients with lumbar disc herniation (LDH, at level L4/5) received were divided into two groups of 47 patients each in the control group treated with ODD and 47 patients in the observation group treated with TELD. The perioperative-related indexes, VAS score, ODI index, modified Macnab evaluation criteria, and the incidence of complications were compared between the two groups. The incision length in the observation group was shorter than that in the control group, the amount of intraoperative blood loss was less than that in the control group, and bedtime and hospital stay were shorter than that in the control group, but the operation time was longer than that in the control group, with statistically significant differences (p <0.01). The VAS score, ODI index, and incidence of postoperative complications in the observation group were lower than those in the control group at 7d, 1 month, 3 months, and 6 months after surgery, while modified Macnab evaluation criteria of lumbar function recovery were higher than that in the control group, the difference was statistically significant (p <0.01). TELD is safe and effective for patients with LDH, which can relieve postoperative pain and help restore lumbar function. Lumbar disc herniation (LDH), Transforaminal endoscopic lumbar discectomy (TELD), Open decompression discectomy (ODD), Visual analogue score (VAS), Oswestry disability index (ODI), Modified Macnab evaluation criteria.

Effect of pre-emptive intravenous paracetamol, magnesium sulfate, and lignocaine on hemodynamic variables during perioperative period in pre-eclampsia patients scheduled for lower segment cesarean section under general anesthesia: A prospective randomized study

Background: Hemodynamic alterations during general anesthesia with endotracheal intubation are due to stimulation of the sympathetic nervous system and catecholamine release. Therefore, it is important to attenuate these responses in pre-eclampsia patients who are already under stress. Aims and Objectives: The present study aimed to evaluate the combined efficacy of paracetamol, magnesium sulfate, and lignocaine in attenuating hemodynamic responses during intubation and perioperative period. Materials and Methods: Eighty ASA II pre-eclampsia patients were randomly divided into two groups. Group PLM received intravenous infusion of paracetamol (1 g) and magnesium sulfate (30 mg/kg) in 100 ml normal saline and IV bolus Inj. lignocaine (1.5 mg/kg) 15 min before induction. Group C received only IV infusion of 100 ml normal saline. Pulse rate (PR), blood pressure (BP), and oxygen saturation were measured at various time intervals up to 40 min of delivery of baby and in up to 240 min in post-operative period. Post-operative visual analog score (VAS) and the time for first rescue analgesia (TRA I) were recorded. Results: Demographic and baseline hemodynamic parameters were comparable in both groups (P&gt;0.05). Changes in PR and BP during laryngoscopy, intubation, and perioperative period were significantly lesser in Group PLM as compared to Group C (P&lt;0.05). The post-operative VAS score was significantly lower whereas TRA I was significantly longer in Group PLM than in Group C at all measuring times (P&lt;0.05). Conclusion: Combination of paracetamol, magnesium sulfate, and lignocaine attenuates hemodynamic responses during laryngoscopy, intubation, and perioperative period along with prolonged post-operative analgesia in cesarean section under general anesthesia in pre-eclampsia patients.

FUNCTIONAL OUTCOME OF FLEXOR HALLUCIS LONGUS TRANSFER AUGMENTED WITH GASTROCNEMIOUS TURNDOWN FLAP IN THE RECONSTRUCTION OF CHRONIC ACHILLES TENDON RUPTURE

Introduction Chronic spontaneus rupture of Achilles tendon commonly occurs in middle aged and elderly person, which often goes undiagnosed or untreated for long duration, resulting in large gap in between two ruptured ends. Disrupted Tendo Achilles causes weakness in plantar exion of foot and abnormal gait. Surgical repair of the chronic rupture have poor result due to large gap in between ends. Different surgical procedures are described in the literature for Reconstruction of chronic Tendo Achilles injuries without any clear superior technique. Purpose of this study is assessment of functional outcome of Flexor Hallucis Longus transfer augmented by turn down Gastrocnemius ap in chronic Tendo achilles rupture. Methods This study Assessed functional outcome of Chronic achilles tendon rupture, reconstructed by Flexor Hallucis Longus transfer augmented by turndown gastrocnemius ap done at orthopaedics department, Bankura Sammilani medical college between november 2020 to october 2021. Patients were followed up for 12 months and then assessed clinically for range of movement , return to normal mobility , persistance of pain and complications . Functional outcome were assesed by American Orthopaedic Foot and Ankle Society(AOFAS) ankle and hindfoot score and Visual analogue Score (VAS). Observations Out of 8 patients, 6 had Excellent AOFAS score of 90 to 100, while 2 patient had a good score of 80 to 89. None had fair or poor score.None of the patients had wound breakdown, ankle stiffness, persistant nerve palsy or rerupture of the reconstructed tendon. Mean VAS score for pain at 12 month follow for 8 patients was 0, as none had any pain complain. None of the patient had any loss of ankle joint movement or stability, All patient resumed there normal day to day activity but none could restart recreational or sporting activity. Conclusions. Flexor Hallucis Longus transfer with turndown ap augmentation gives good to excellent outcome with minimal complication, if meticulous soft tissue handling and proper wound closure are done.

Implementing the transvaginal natural orifice transluminal endoscopic surgery (vNOTES) "first" strategy in benign gynecological surgeries.

The use of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) as the first choice of surgical route for patients scheduled to undergo conventional laparoscopy is still being debated. We aimed to evaluate and compare the outcomes of the "vNOTES first" strategy in benign gynecological cases. All benign gynecological surgeries were initiated using vNOTES during the study period, regardless of the difficulty. Surgical outcomes, short-term patient satisfaction and sexual pain were compared between hysterectomies, adnexal and diagnostic procedures. Visual Analog Score (VAS), Patients Global Impressions of Improvements scale (PGI-I) and Female Sexual Function Index (FSFI) were used to assess the postoperative pain, satisfaction and sexual pain, respectively. A total of 105 vNOTES procedures were performed during the study period: 63 (60.58%) adnexal procedures, 36 (34.62%) hysterectomies, 5 (4.81%) diagnostic procedures and one (0.96%) myomectomy. The median 24th hour VAS scores for adnexal, hysterectomy, and diagnostic procedures were 1.29 ± 1.41, 2.06 ± 2.08, and 2.6 ± 2.41, respectively. The satisfaction rate was 96.19% at the 1st postoperative week and 97.14% at the first month. There was either no change or a slight improvement in the patients' total score on the FSFI/pain domain before and after surgery. There were two conversions (1.9%) from vNOTES to laparoscopy and laparotomy, and two (5.56%) bladder injuries in hysterectomy cases. Implementing the vNOTES technique as an initial approach for all benign gynecological surgeries seems feasible, safe and satisfactory, even in those with a non-prolapsed or enlarged uterus and those that have previously undergone abdominal surgery. The pain scores were found to be low and patients stated a high satisfaction with no or better change in their sexual life.

Improvement of Symptoms in Patients Affected by Chronic Atrophic Gastritis Using L-Cysteine (Acetium®)

Background: Chronic atrophic gastritis (CAG) alone is a precancerous condition for gastric cancer. Achlorhydria plays an important role in the formation of a class I carcinogen, acetaldehyde. L-cysteine has been claimed to bind acetaldehyde covalently. Symptoms are present in 55% of CAG patients, of whom 70% have upper gastrointestinal complaints. The aim of this study was to investigate the properties of L-cysteine in the modification of symptom patterns in CAG patients. Methods: Consecutive patients with histological diagnosis of CAG (OLGA ≥1 with gastric corpus involvement) were evaluated with serological determination of gastric function, clinical assessment of symptoms using the visual analog score (VAS) and the global symptomatic score (GSS), and considered for therapy with L-cysteine, 300 mg daily. Data regarding symptoms were collected at enrollment and after 3, 6, 12, 18, and 24 months, with an ultimate follow-up of 2 years. Results: A total of 330 patients with CAG were divided in group 1 (77 patients treated with L-cysteine) and group 2 (50 patients who received no specific treatment – control group). A statistically significant improvement in the VAS score (7.8 at baseline vs. 4.5 after 24 months; p < 0.01) was observed in patients treated with L-cysteine, while no significant changes in symptom pattern/intensity were recorded in the 2-year follow-up of untreated patients with CAG. Conclusions: Long-term treatment with L-cysteine provides symptom improvement in CAG patients and might be proposed as maintenance therapy in such patients.

Single posterior approach for circumferential debridement and anterior reconstruction using fibular allograft in patients with skipped multifocal spinal tuberculosis

BackgroundSkipped multifocal spinal tuberculosis (TB) is an atypical presentation of spinal TB. Surgical treatment for these unusual cases remains a challenge for spine surgeons. In our institute, we used single-stage circumferential debridement and anterior reconstruction with fibular allograft followed by posterior instrumentation through posterior-only approach for these patients. This study aimed to determine the efficacy and feasibility of this technique.MethodsTwelve patients with skipped multifocal spinal TB who received our treatment method from January 2012 to June 2020 were enrolled in this study. The visual analog score (VAS), laboratory data, comorbidities, complications, and neurologic status based on Frankel scale were recorded. The patients’ clinical conditions were evaluated based on modified Brodsky’s criteria and Oswestry Disability Index (ODI).ResultsAll the patients were infection free at the end of the treatment. The average VAS score was 7.5 (range, 7–8) before surgery and decreased to 2.1 (range, 1–3) one year postoperatively. No one experienced any severe complications such as neurologic deterioration, fixation failure, or bone graft dislodgement. Out of the three patients requiring debridement surgery, two had wound infection and one had seroma formation. The ODI score improved from 76.8 (range, 70–84) preoperatively to 25.5 (range, 22–28) one year after surgery. All patients achieved good or excellent outcome based on modified Brodsky’s criteria one year postoperatively.ConclusionsIn our study, the patients could achieve a good clinical outcome. This technique could be an alternative for patients with skipped spinal TB.

Short-Term Efficacy of Using a Novel Low-Volume Bone Marrow Aspiration Technique to Treat Knee Osteoarthritis: A Retrospective Cohort Study.

Intra-articular bone marrow concentrate (BMC) and aspirate (BMA) injections have been used with mixed results to treat osteoarthritis (OA). Given the various aspiration and concentration methods available for preparing bone marrow, more data are needed to identify the optimal bone marrow harvesting techniques to treat OA. This retrospective cohort study examined the effect of using low-volume BMAs harvested using the Marrow Cellution™ (MC) device on 160 patients (262 knees) suffering from pain due to knee OA, KL grades 2-4, that did not respond to conservative treatment. Changes in visual analog scores (VAS) for overall daily activity were examined over a six-month time frame in these patients (63.5 ± 0.97 years of age; 48.1% male). In addition, changes in the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Patient Global Impression of Change (PGIC scores) were examined over the same time frame in a smaller subset of patients (95 patients including 172 knees). There was a statistically significant improvement in VAS scores for overall daily activity 6 months postprocedure in the study population, 7.29 ± 0.27 vs. 3.76 ± 0.34 (p < 0.0001), as well as statistically significant improvements in WOMAC scores, 49.3 ± 4.27 vs. 66.3 ± 4.08 (p < 0.0001). On the individual level, 71% of the cases displayed VAS improvements and 61% of the cases displayed WOMAC improvements that exceeded levels previous studies determined to be the minimal clinically important difference (MCID) for knee OA treatments. The improvements in WOMAC scores were also seen in both the WOMAC pain subscore, 52.2 ± 4.39 vs. 72.2 ± 4.36 (p < 0.0001) and the WOMAC function subscore, 51.6 ± 4.67 vs. 69.0 ± 4.36 (p < 0.0001). In addition, the PGIC scores measuring patient satisfaction improved from 4.03 ± 0.26 at 6 weeks postprocedure to 4.65 ± 0.28 at 6 months postprocedure (p < 0.0001). Knee OA patients treated with MC BMA intra-articular injections exhibited significant reductions in VAS pain scores and significant improvements in WOMAC scores that exceeded the minimal clinically important difference thresholds. In addition, reductions in VAS pain scores and improvements in WOMAC scores correlated with higher PGIC scores.

“TO COMPARE THE EFFICACY OF INTRAVENOUS PARACETAMOL VS COMBINATION OF INTRAVENOUS PARACETAMOL AND MAGNESIUM SULPHATE ON POST OPERATIVE PAIN RELIEF.”

Introduction: Recent studies have shown the positive effect of magnesium sulphate as an adjunct on post-operative pain relief. This study is comparing effect of paracetamol with and without magnesium sulphate as an adjunct on post operating pain relief. AIMS: “To compare the efcacy of intravenous paracetamol vs combination of intravenous paracetamol and magnesium sulphate on post operative pain relief.” (1) To compare the duration of post operative Objectives: analgesia based on VAS score. (2) To note the requirement of rescue analgesia in the rst 24 hrs post operative period. This ra Materials And Methods: ndomised trial was conducted on 30 patients at Dr. D.Y.Patil medical college and research hospital. The patients who were candidates were randomised into two groups, Group 1 (n=15) and Group 2 (n=15). Spinal anaesthesia was given to all the patients. Group 1 were given 1 gm of IV paracetamol (100ml) with 100 ml of normal saline and group 2 were given 1gm of IV paracetamol (100ml) with 50mg/kg Magnesium sulphate in 100 ml of normal saline (max 2gm). VAS (visual analogue score) was used to assess post operative pain relief and requirement of rescue analgesia post operatively was measured. Result: There was a decrease inn rescue analgesic consumption and pain in the group receiving MgSo4 as an adjunct. In comparison to group 1, Group 2 showed statistically signicant reduction in post operative pain at 12, 24 and 36 hours. Intravenous MgSo4 with Conclusion: paracetamol is effective in reducing post operative pain and requirent of total opioid consumption in 72 hour post operative period as well as increased total duration of analgesia.

Comparison of freehand technique and a novel laser guiding navigation in distal locking of femoral intramedullary nails: a randomized controlled trial

BackgroundIntramedullary nail (IMN) is one of the key essential minimally invasive “weapons” in orthopaedic trauma, while the distal locking is still challenging for surgeons. Although there are various inventions and technologies to improve the locking procedure, there are still problems such as inaccurate positioning, excessive radiation exposure, low first success rate and long learning curve. Therefore, a new laser guiding navigation device was designed and compared with the traditional freehand (FH) technique in the distal locking of femoral IMN.MethodsThis randomized controlled single-blind trial recruited patients with femoral diaphyseal fracture. The self-designed laser navigation device (laser group) and freehand technique (FH group) were used in the distal locking of the IMNs. The patients enrolled were randomized into FH group and laser group, all operations were performed by two surgeons of the same level. The differences between the two groups were compared in terms of radiation exposure time, operative time, first success rate, blood loss, visual analogue score (VAS), Harris score and healing time.Results32 patients ended the study period and 16 patients in each group. The results showed that the laser group was better than the FH group in terms of distal locking time (10(9/11) vs 19.5 (17.25/21) min, Z = 4.83, P < 0.001), distal locking radiation exposure time (46.5 (41.25/51.75) vs 105 (88.25/140) s, Z = 4.807, P < 0.001), first success rate (30/32 vs 20/32, χ2 = 9.143, P = 0.002) and blood loss (60 (50–100) vs 150 (105–192.5) mL, Z = 3.610, P = 0.0003). There was no difference in Harris score, VAS score, or fracture healing time between the two groups.ConclusionCompared with the FH technique, the novel laser guiding navigation device for distal locking of femoral IMN has the advantages of shorter operative time, less radiation exposure and higher first success rate.Trial registration Chinese Clinical Trial Registry, ChiCTR2200060236. Registered 23 May 2022, https://www.chictr.org.cn/showprojen.aspx?proj=169130

Comparison of prone-supine versus supine position for the treatment of pilon fractures via modified posteromedial approach combined with anterolateral approach

BackgroundMost of modified posteromedial approaches require prone position for the treatment of pilon fractures. We describe the technique of modified posteromedial approach under supine position. The goal of the study was to compare the radiographic and clinical outcomes of prone-supine versus supine position for the treatment of pilon fractures via modified posteromedial approach combined with anterolateral approach. MethodsA total of 50 retrospectively consecutive pilon fractures that underwent open reduction internal fixation via modified posteromedial approach combined with anterolateral approach from 2016 to 2019 were reviewed at least a two-year follow up. The positions of patients were divided into two groups: prone-supine versus supine position (26 vs 24, respectively). The operation time, radiographic outcomes including bone union time and ratio of congruent articular reduction were evaluated. The post-operative function was evaluated using the Manchester Oxford score (MOXFQ) and the visual analogue score (VAS). The motion of ankle joint and complications and were also compared. ResultsThe mean follow-up was 42.2(24.7–73.0) months in the prone-supine group and 42.7(37.3–56.5) months in the supine group (P = .87). The mean operation time was 141.9 ± 10.1 min in the prone-supine group and 107.5 ± 18.9 min in the supine group (P = .00). There was no significant difference in the bone union time and ratio of congruent articular reduction between the two groups. There was no significant difference in the final MOXFQ score, VAS score, and the mean range of ankle motion between the two groups (P > .05). The total incidence of complications was 11.5% in the prone-supine group and 16.6% in the supine group (P = .66). ConclusionThe patient in the prone-supine position versus supine position for pilon fractures via modified posteromedial approach combined with anterolateral approach contributed comparable quality of reduction, bone union time functional outcomes and complications. The supine technique was significantly shorter in terms of operation time.

Comparison of Effect of Three Different Surgical Procedures on Ankle Joint Function Rehabilitation of Patients with Hepple V Talus Osteochondral Injury.

Objective To discuss and compare the effects of three different surgical procedures on ankle function rehabilitation of patients with Hepple V talus osteochondral injury. Methods A total of 60 patients with Hepple V talus osteochondral injury admitted to our hospital from January 2020 to January 2021, among which 17 patients in study group 1 received microfracture surgery, 20 patients in study group 2 received osteochondral autologous transplantation, and 23 patients in study group 3 received with periosteal iliac bone transplantation. The range of motion (ROM) of the patients' angle was evaluated by the goniometer before and after the treatment. The ankle function was evaluated by the ankle-hindfoot score of American Orthopedic Foot and Ankle Society (AOFAS). The ankle joint pain was evaluated by visual analogue score (VAS). The surgical efficacy was evaluated 12 months after surgery, and complications and nursing satisfaction were observed and recorded. Results There was no significant difference in ROM, AOFAS score, and VAS score among the three groups before the treatment (P > 0.05). ROM and AOFAS score of the three groups were improved, and VAS score was decreased at 6 months and 12 months after treatment (P < 0.05). ROM and AOFAS score of group 2 and group 3 were higher than those of group 1, while the VAS score was lower than that of group 1, indicating significant difference (P < 0.05). There was no significant difference in ROM, AOFAS, and VAS score between group 2 and group 3 (P > 0.05). The surgical efficacy of group 2 and group 3 was higher than that of group 1, indicating statistical significance (P < 0.05), while there was no significant difference in the surgical significance between group 2 and group 3 (P > 0.05). There was no significant difference in complication rate among the three groups (P > 0.05), and the treatment satisfaction of group 2 and group 3 was higher than that of group 1, indicating statistical significance (P < 0.05), but there was no significant difference between group 2 and group 3 (P > 0.05). Conclusion Three different surgical procedures have good therapeutic effect for Hepple V talus osteochondral injury. Osteochondral autologous transplantation and periosteal iliac bone transplantation can reduce the pain of ankle joint, promote the effect of ankle joint function recovery, which can effectively improve patient satisfaction. It is suggested to choose the surgical procedure according to the actual situation of patients.

Clinical Study of Wrist Arthroscopy Combined with Oblique Ulnar Shortening Osteotomy in the Treatment of Ulnar Impaction Syndrome.

To explore the clinical effects of wrist arthroscopy combined with oblique ulnar shortening osteotomy in the treatment of ulnar impaction syndrome. This was a retrospective study of 60 patients with ulnar impaction syndrome who were admitted to our department from January 2016 to December 2019. According to different surgical methods, they were divided into an observation group and a control group, with 30 cases in each group. The control group was treated with oblique ulnar shortening osteotomy, and the observation group used wrist arthroscopy based on the control group. The two groups of patients were compared in terms of wrist function before and 12months after surgery. We compared the Disabilities of the Arm, Shoulder, and Hand Score (DASH Score), Patient-Rated Wrist Evaluation Score (PRWE Score), Visual Analog Score (VAS), and ulnar variation between the two groups at 12months after surgery. The excellent and good rates by Mayo wrist score were compared between the two groups at the last follow-up. All patients were followed up for 12-36months, with an average of 14.5months. Bone union was achieved at the oblique osteotomy of the ulna, with an average healing time of 13.6 weeks. The observation group was examined by wrist arthroscopy, and the triangular fibrocartilage complex (TFCC) Palmer classification was confirmed in three cases of type IIA, seven cases of type IIB, 14 cases of type IIC, and six cases of type IID. Compared with before surgery, the grip strength, flexion-extension, ulnar radial deflection, and forearm rotation of the two groups of patients were significantly improved at 12months after surgery. The DASH score, PRWE score, and VAS score of the observation group were better than those of the control group, and the difference in ulnar shortening length was not statistically significant between the two groups. The excellent and good rates of the observation group (93.3%) were better than those of the control group (87.5%) at the last follow-up, and the difference was statistically significant. Compared with oblique ulnar shortening osteotomy alone, combined wrist arthroscopy can better reduce the pain of patients with ulnar impaction syndrome, restore wrist function, and improve the excellent and good rates. Therefore, it is clinically worthy of promotion.

A comparative study of efficacy of fractional carbon dioxide laser with and without platelet rich plasma in treatment of facial acne scars

Scarring and facial disfigurement caused by severe acne can cause significant physical and psychosocial distress, particularly in adolescents. In treating acne scars, dermatologists face a therapeutic challenge. Ablative lasers Erbium YAG lasers or carbon dioxide lasers are effective, but they are associated with erythema, post-inflammatory hyperpigmentation, a longer recovery time, and scarring. With the introduction of fractional carbon dioxide lasers, acne scar treatment has become much more effective. PRP contains growth factors, which helps to speed up the natural healing process. As a result, combining fractional CO2 laser with platelet rich plasma has resulted in significant improvement of acne scars with good cosmetic results and skin rejuvenation. Through this study, we intend to assess the efficacy of fractional carbon dioxide laser with platelet rich plasma versus fractional carbon dioxide laser alone in the improvement of facial acne scars.To compare the efficacy of fractional carbon dioxide laser with and without platelet rich plasma (PRP) in treatment of facial acne scars.A total of 30 patients (18-40 years) with facial atrophic scars who attended the out-patient department at the Department of Dermatology, Venereology, and Leprosy, Adichunchanagiri Hospital and Research Centre, B.G. Nagara were randomly assigned to groups A (fractional CO2 with PRP group) and B (fractional CO2 group). Patients in both groups received four sequential treatments, with a four-week interval between each session. A side-by-side comparison of preoperative and post-operative photographs was used to assess the clinical improvement of atrophic scars one month after the last session, using Goodman and Baron's qualitative and quantitative grading system. Furthermore, patients were asked to provide feedback on scar improvement using the patient satisfaction Visual Analogue Score (VAS).Based on Goodman and Baron’s qualitative assessment one month after the last session (4 sessions), 13.33 percent (2) of patients in group A showed reduction by three grades compared to 6.66 percent (1) patient in group B, and 60 percent (9) of patients in both groups showed scar reduction by two grades. Based on Goodman and Baron’s quantitative assessment one month after the last session (4 sessions), 20 percent showed very good reduction in group A compared to 13.3 percent in group B, and 40 percent showed good reduction in group A compared to 33.3 percent in group B. [p=0.732, not statistically significant]. Patients treated with fractional carbon dioxide laser with PRP in group A had a slightly better mean percentage reduction of post acne scars at one month after the last session (4 sessions) compared to patients treated with fractional carbon dioxide laser in group B [75.83 vs 69.34 percent; p=0.72 which was statistically not significant]. At one month after the last treatment session (4 sessions), 66.67 percent (10) of patients in Group A were very satisfied with the treatment, compared to 46.67 percent (7) of patients in Group B. After four treatment sessions, the mean Patient Satisfaction VAS Score in Group A was 2.0, compared to 1.7 in Group B [p=0.000082, which was found to be statistically significant]. The result of this study shows that combination of fractional CO2 laser with intradermal PRP is slightly more efficacious than fractional carbon dioxide laser monotherapy in management of facial acne scars. Patients receiving fractional carbon dioxide laser with PRP were more satisfied with the treatment outcome.

Abstract 11 Outcome of Patients Treated with Umbilical Cord Blood and Homologous Serum Eye Drops

IntroductionSeveral authors have demonstrated the safety and efficacy of CBS eye drops in the treatment of severe DE with or without Sjogren’s syndrome (SS-I), ocular graft versus host disease (GVHD), persistent corneal epithelial defects, recurrent corneal erosions, chemical burns, and neurotrophic keratitis.ObjectiveTo compare the efficacy of cord blood serum (CBS) and adult donor peripheral blood serum (PBS) eye drops (prepared, standardized, and controlled in the Emilia Romagna Cord Blood Bank) in the treatment of severe dry eye disease (DED), a multicenter randomized, double masked, crossover clinical trial was designed.MethodsSixty patients diagnosed with severe DED associated with persistent corneal epithelial defects were randomized and equally assigned to group A (treated with CBS) or group B (treated with PBS) , eye drops administered 8 times/day for 1 month. Primary outcome was the pre-treatment and post-treatment change in corneal fluorescein staining. Secondary outcomes included the pretreatment and post-treatment change in ocular surface disease index (OSDI), questionnaire and Visual Analogue Score (VAS) of subjective symptoms, Schirmer I test, tear break-up time, and conjunctival staining. Patients with relapse in signs or symptoms after further 2 months switched to the remaining group for one additional month.ResultsCorneal staining was more significantly reduced after CBS treatment; both VAS and OSDI score reduction was observed in both groups, but group A reported significantly less grittiness and pain. Nineteen patients shifted in the crossover period. The within individual comparison confirmed a better recovery in the CBS treatment period. Epidermal growth factor, transforming growth factor, and platelet-derived growth factor content was associated with reduction of epithelial damage. Levels of interleukins were positively associated with symptoms decrease.DiscussionDED signs improved after both CBS and PBS treatments with potential advantages of CBS for subjective symptoms and corneal damage reduction. In addition to the very important therapeutic value of EDHO products, considering the CB units not suitable for transplantation, we have identified novel non-wasteful clinical applications of those allogeneic biological products, resulting in an increase of ethical motivation of families generously donating CB for public benefit.Figure 1.Slit-lamp photographs with fluorescein staining in patient running both period 1 and period 2 of the study. Before PBS treatment, the corneal epithelium was stained diffusely (top left). One month after treatment, the severity of the damage decreased, especially in the central area (top right). Two months after the end of the treatment, the level of epithelial damage worsened and patient entered period 2 (bottom left). After 1 month of CBS treatment, a diffuse decrease in staining was observed in all areas. In this patient, a better improvement was observed after the CBS treatment compared with the PBS treatment.

Arthroscopic anatomical reconstruction of lateral collateral ligaments with ligament advanced reinforcement system artificial ligament for chronic ankle instability.

BACKGROUNDRecently, the use of ligament advanced reinforcement system (LARS) artificial ligament, a new graft which has several unique advantages such as no donor-site morbidity, early recovery and no risk of disease transmission which has been a significant breakthrough for anatomical ligament reconstruction. Growing studies suggested that the special design of the LARS ligament with open fibers in its intra-articular part was believed to be more resistant to torsional fatigue and wearing. However, the safety and efficacy of LARS artificial ligament for ankle joint lateral collateral ankle ligament reconstruction has not been defined to date.AIMTo evaluate the clinical results of all-arthroscopic anatomical reconstruction of ankle joint lateral collateral ligaments with the LARS artificial ligament for chronic ankle instability.METHODSTwenty-two patients with chronic lateral instability underwent anatomical reconstruction of the lateral collateral ligaments of ankle with LARS artificial ligament. The visual analogue score (VAS), American Orthopaedic Foot and Ankle Society score (AOFAS score) and Karlsson score were used to evaluate the clinical results before and after surgery.RESULTSA total of 22 patients (22 ankles) were followed up for a mean of 12 mo. All patients reported significant improvement compared to their preoperative status. The mean AOFAS score improved from 42.3 ± 4.9 preoperatively to 90.4 ± 6.7 postoperatively. The mean Karlsson score improved from 38.5 ± 3.2 preoperatively to 90.1 ± 7.8 postoperatively. The mean VAS score improved from 1.9 ± 2.5 preoperatively to 0.8 ± 1.7 postoperatively.CONCLUSIONAll-arthroscopic anatomical reconstruction of the lateral collateral ligaments with LARS artificial ligament achieved a satisfactory surgical outcome for chronic ankle instability.