Fracture union and complication following internal fixation of clavicle by plate and screw

Background: Among all long bones clavicle is the only bone placed horizontally and has membranous ossification. Clavicle fractures accounting for about 2.6% of total body fractures and 34% to 45% of total shoulder girdle injuries in adults. Most fractures occur in middle third of clavicle and common in young male patients. It has wide range of management from conservative to variant internal fixation. Each procedure has its own outcome and complications. We tried to find out the outcome and complications following internal fixation of clavicle with plate and screws.Methods: In a prospective study 50 patients of fracture mid shaft clavicle who were treated with plate and screw were followed for a period of two years. Only adults more than 18 years were included in the study. All patients were followed at 2nd post-operative day 5th post-operative day 14th post-operative day and at 1, 2, 6, 12 and 24 months. Only two parameters were observed i.e. union of fracture and post-operative complications.Results: Of all patients operated with plate and screw 48 patients had good radiological union by six months. Only two patients had non-union and one with implant failure at 12 months. Of complications one had stitch abscess and seven had hardware discomfort.Conclusions: Clavicle fracture in adults has multimodal treatment option. Though conservative management has good results it has high chance of mal-union and non-union. Operative fixation should be opted for adult individuals where chance of non-union is high. Plate and screw fixation has good results in terms of union with least complication.

Timing of anterior cruciate ligament reconstruction and its effect on associated chondral damage and meniscal injury: a prospective observational study

Background: Following an anterior cruciate ligament (ACL) tear, associated injuries in the knee involving menisci and articular cartilage increase with time. This study was performed to assess the distribution of secondary injuries after an ACL tear with time and identify a suitable timing for the reconstruction surgery. Methods: 74 patients with an ACL tear were divided into three groups based on time since injury- less than six months, six months to one year, and greater than one year. The odds of finding each lesion in every group were calculated and tested for statistical significance. Receiver operating characteristic curves (ROC) were drawn to predict individual lesions with time since injury. The diagnostic performance and statistical significance of these tests were identified. Results: The odds of finding all lesions were greater than one after a year of ACL tear but only chondral damage was statistically significant (p=0.025). Poor diagnostic accuracy was observed for medial meniscal injury even after three years of an ACL tear. Chondral injury showed a good area under the curve (0.817) which predicted chondral damage with a sensitivity of 62% at a cut-off of three years after the ACL injury. Conclusions: After three years of ACL tear, meniscal injuries could not be accurately predicted. However, a significant rise in chondral injuries could be seen and predicted accurately with good sensitivity. There could be a role of MRI or arthroscopy to assess the extent of injury of articular cartilage in patients who do not undergo ACL reconstruction after this time.

Evolution and Clinical Advances of Platelet-Rich Fibrin in Musculoskeletal Regeneration

Over the past few decades, various forms of platelet concentrates have evolved with significant clinical utility. The newer generation products, including leukocyte-platelet-rich fibrin (L-PRF) and advanced platelet-rich fibrin (A-PRF), have shown superior biological properties in musculoskeletal regeneration than the first-generation concentrates, such as platelet-rich plasma (PRP) and plasma rich in growth factors. These newer platelet concentrates have a complete matrix of physiological fibrin that acts as a scaffold with a three-dimensional (3D) architecture. Further, it facilitates intercellular signaling and migration, thereby promoting angiogenic, chondrogenic, and osteogenic activities. A-PRF with higher leukocyte inclusion possesses antimicrobial activity than the first generations. Due to the presence of enormous amounts of growth factors and anti-inflammatory cytokines that are released, A-PRF has the potential to replicate the various physiological and immunological factors of wound healing. In addition, there are more neutrophils, monocytes, and macrophages, all of which secrete essential chemotactic molecules. As a result, both L-PRF and A-PRF are used in the management of musculoskeletal conditions, such as chondral injuries, tendinopathies, tissue regeneration, and other sports-related injuries. In addition to this, its applications have been expanded to include the fields of reconstructive cosmetic surgery, wound healing in diabetic patients, and maxillofacial surgeries