Background:Platelet rich plasma (PRP) extract has shown to be a general stimulation for repair and currently used widely in various sports injury. A prospective observational study was done to assess the efficacy of autologous PRP injection in lateral epicondylitis of elbow, and compare the result with low level laser therapy.Materials and Methods:The trial was conducted at a tertiary care center for a period of 2 years. Eighty-one patients with chronic lateral epicondylitis were divided into two groups. PRP group (n = 39) and laser therapy group (n = 42). The primary analysis included Nirschl pain score, local tenderness, pain on wrist extension, grip strength, elbow swelling were clinically assessed at different interval of followup (minimum followup: 52 weeks) and; clinical and functional outcome evaluated at final followup. The statistical analysis were done.Results:The mean Nirschl pain score decreased significantly from baseline in PRP when compared with low level laser therapy (P ≤ 0.05).Conclusions:Treatment of patients with chronic lateral epicondylitis with PRP extract reduced pain and significantly increased function, exceeding the effect of low level laser therapy on long term followup. Low-level laser therapy is better in the short term period, but on long term followup injection PRP therapy is better than laser therapy in lateral epicondylitis.

BACKGROUND:Anterior knee pain has been described as the most common complication after intramedullary nailing of fracture shaft of tibia. Dissection of the patellar tendon and its sheath during transtendinous nailing is thought to be as one of the contributing causes of chronic anterior knee pain. The purpose of this prospective, randomized study was to compare the incidence of anterior knee pain after intramedullary nailing of a tibial shaft fracture with transtendinous and paratendinous incision technique. MATERIAL AND METHODS: From April 2012 to October 2013 eighty patients with closed tibial shaft fractures were admitted and treated in our institution. Patients were randomized for treatment with paratendinous or transtendinous nailing (as 24 patients did not complete their follow up or were lost in follow up, so 56 patients were analyzed finally). For assessment we used visual analogue scales to report the level of anterior knee pain. The scales described by Lysholm and Gillquist and by Tegner et al., were also used to quantitate the functional results. RESULTS: 12 of the 28 (42%) patients treated with transtendinous nailing. reported anterior knee pain whereas 8 patients out of 28 (28%), in which paratendinous technique was used had persistent anterior knee pain after minimum final follow up of 24 weeks, with no significant statistical difference. The Lysholm, Tegner functional scoring systems showed a significant difference between the two groups. CONCLUSION: Compared with a transtendinous approach, a paratendinous approach for nail insertion does not reduce the incidence of chronic anterior knee pain or functional impairment after intramedullary nailing of a tibial shaft fracture. In long term, anterior knee pain seems to disappear from many patients. Since our study is small and have short duration of follow up, further larger studies and long duration of follow up is needed to establish the results.

BACKGROUNDMetaphyseal fractures of long bones of lower limb are difficult to manage. In our study, we have evaluated the radiological and functional outcome of minimally invasive plate osteosynthesis (MIPO) technique for metaphyseal fracture of femur and tibia. MATERIALS AND METHODSA total of 37 metaphyseal fractures of long bone of lower limb were included in the study. The fractures were treated with minimal incisions, both at proximal and distal ends of plate. The anatomical metaphyseal locking plate was then inserted subperiosteally and the fracture was bridged after which the plate was fixed. The patients were followed up and the progresses were evaluated at regular interval by Johner-Wruhs' criterion and lower extremity functional score. RESULTSAll the fractures united well. The mean time of union of distal femur, proximal and distal tibia are 18 (range 14 -24), 18 (range 14 -22) and 17 (range 16 -24) weeks respectively. The mean range of motion at knee of fracture around knee was 105°, while for fracture at ankle the range of motion was a mean dorsiflexion of 19° and mean 30° plantar flexion. According to Johner-Wruhs' criterion results were excellent in 14, good in 17, fair in 5 and poor in 1 patient. By LEFS system, 34 patients have no difficulty in doing their work, while only 3 patients have a little bit of difficulty. No patients required bone grafting. The complication rates were also low. CONCLUSIONFor metaphyseal fractures, MIPO can be regarded as an optimal treatment modality which achieves good bone union and functional results with minimum soft tissue damage.

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Background: The aim of this study was to report the results of laminectomy with short-segment pedicle screw fixation in thoracolumbar fracture. Materials and Methods: Forty-two patients were analyzed prospectively, followed up in the outpatient department for the period of 24 months. Results: Most of the patients in the study had reasonable to good neurological recovery in the postoperative period assessed in the form of American Spinal Cord Injury Association (ASIA) score. There was also an excellent improvement in the components of anatomical reduction such as vertebral height, Cobb’s angle, and anterior wedge angle, which was directly related to functional recovery of the patient. Patients postoperatively also got relieved in pain in the dorsolumbar region assessed based on Denis pain scale. Conclusion: Laminectomy with pedicle screw fixation is an excellent option for patients with thoracolumbar fracture; it not only decompresses the spine but also provides stability with minimal manageable complications.