Local injection of leukocyte rich platelet rich plasma produced higher radius union scoring system than local injection of pure platelet rich plasma in conservative therapy of intra-articular closed distal radius fractures

Background: Distal radius fracture often occurs both extra-articular and intra-articular, covering all ages. The use of autologous platelet rich plasma (PRP) consisting of leucocytes rich-PRP (L-PRP) and pure-PRP (P-PRP) thought can help in bone healing process. This study aimed to determine that the administration of L-PRP provides a better healing rate than P-PRP in intra-articular closed distal radius fractures after conservative treatment.Methods: This was a single-blinded experimental study with stratified randomized post-test only group design involving 51 patients with closed distal fractures undergoing closed reduction, consisting of 17 patients per study group. Group 1 received placebo, group 2 received P-PRP, and group 3 with L-PRP. Each group was then re-evaluated using x-ray at week 2, 3, and 6. RUSS score was then measured. Data was analysed using descriptive statistics and normality test, homogeneity test and inferential test were performed to determine the effect of L-PRP, P-PRP on the union rate of fracture distal radius. All obtained data was analysed using SPSS statistics 22 software.Results: Between control and P-PRP group, there was significant difference in mean RUSS with p value of 0.012. Between control and L-PRP injection group, there was a significant difference in mean RUSS with p value of 0.000. Between P-PRP and L-PRP group, there was also significant mean RUSS difference with p value of 0.003.Conclusions: There was a significant difference between the control group given placebo and the group P-PRP and L-PRP in closed fractures of the intraarticular radius after conservative therapy

Pathological fracture of subtrochanter femur, soft tissue infection along the fracture site, shaft femur bone cortex thickening and blastic lession on contralateral shaft femur due to renal osteodystrophy on the end stage renal disease patient: a case report

Renal osteodystrophy (ROD) is a skeletal complication resulting from pathologic alterations in calcium, phosphate, and bone metabolism. The potential link between bone turnover and bone quality is an important question meriting study because of the relatively high incidence of fractures reported. In this case presents a pathological fracture on a routinely hemodialyzed woman. She complained pain on her left subtrochanteric area after low energy trauma accident. A thickening of the shaft femoral bone cortex was also found, reflecting the osteosclerosis event due to imbalance of proliferation and differentiation of osteoblast with increase bone formation. She also had a blastic lesion on her contralateral shaft femoral during the bone survey, but this finding remains asymptomatic. Decreased osteoclastic activity may contribute to cortical thickening, resulting in overall bone mass increase, which may lead to decreased elasticity of the bone or impaired repair capabilities, therefore increasing the risk of fracture. The blastic lesion that occurred on contralateral side may indicated effect of ROD or primary bone lesion. Careful assessment and holistic management of patients with kidney disease is necessary to achieve optimal outcome. The prevention of falls is also an important strategy to prevent pathological fractures. End stage renal disease (ESRD) have reduced bone mineral density, a risk factor for fracture incidence. Careful anamnesis and clinical examination are needed for diagnosis and management

Characteristic of risk factor of thyroid cancer related metastatic bone disease at Sanglah General Hospital Denpasar between January 2013 to March 2019

Background: Metastatic bone disease (MBD) causes a massive morbidity, pain, and disability for the sufferers. Thyroid carcinoma, which is the most common endocrine cancer worldwide, also contributes to the increased rate of MBD, as 60% of patients with thyroid carcinoma experience bone metastasis. An urgency to further analyze the risk factors of bone metastasis in thyroid cancer is necessary in order to prevent and treat this unwanted occurrence earlier and better.Methods: A descriptive retrospective study was conducted using patients’s medical record data obtained from Sanglah General Hospital between January 2013 until March 2019. The variables obtained were sex, age, diagnosis, management, and fracture site.Results: There were 15 patients involved in this study, presenting with pathological fracture due to MBD from thyroid cancer. Ten patients were female (66.7%)  and 5 were male (33.3%). According to the age group, 2 patients (13.3%) were 60 years old, while the majority of 8 patients (53.4%) were 40-60 years old. From the pathological result, 9 patients had follicular neoplasm (60%) and 5 patients had papillary neoplasm (33%). The most common site of metastasis was humerus in 7 patients (47%), while the other sites were femur, pelvic, and tibia.Conclusions: According to this series, there are several risk factors related to MBD from thyroid carcinoma, including female gender, the age of 40-60 years old, and follicular type neoplasm. A further study with bigger amount of sample is needed to improve the result