Case Series: Wide-Awake Local Anaesthesia Without Tourniquet (WALANT) for Camitz Transfer

Background: Wide-Awake Local Anaesthesia Without Tourniquet (WALANT), with the benefit of simplicity and a low complication rate, is a well-recognised procedure in orthopaedic surgery. To date, there is no report using WALANT technique with the Camitz transfer procedure. The aim of this study is to determine the early outcomes of using WALANT for Camitz transfer and compare these with outcomes of similar procedures in literature. Methods: Between January 2012 and January 2018, all patients with severe carpal tunnel syndrome (CTS) with thenar muscle atrophy who underwent the Camitz transfer procedure as day surgery under the WALANT technique at the Thammasat University Hospital were included. With the WALANT technique, the 10 mL of prepared anaesthesia was injected into the area around the palmaris longus tendon from 5-cm proximal to the distal wrist crease to the distal palmar crease, while an additional 10 mL was injected from the radial side of the metacarpophalangeal joint of the thumb to the distal wrist crease before the operation. Upon completion of the operation, the patients' hand was placed in a thumb spica splint. Patient demographic data, visual analogue scale (VAS) during injection and during procedure, operative time, blood lost and complications were recorded. Results: Thirty-six patients (8 males and 28 females) were included. The average age of the patients was 65.9 (37-87) years old. The average VAS score during the anaesthetic injection was 6.22 (5-8). The average VAS pain score during the operation was 0.52 (0-3). The average operative time was 27.06 (17-47) minutes. The mean intraoperative blood loss was 3 (2.4-6.8) mL. All patients underwent the procedure without any complications. Conclusions: The WALANT technique is safe and can be used as alternative anaesthesia for the Camitz transfer. Level of Evidence: Level IV (Therapeutic).

The Efficacy of Ruesi Dadton and Yoga on Reducing Neck and Shoulder Pain in Office Workers

Work-related Musculoskeletal Disorders can cause neck and shoulder pain in office workers. The research objective was to investigate the efficacy of Ruesi Dadton exercise (RD) and Yoga exercise (YE) compared with Stretching exercise (SE) on reducing neck and shoulder pain in office workers. A single-blind randomized controlled trial was conducted at Thai Traditional Health Promotion Center, Thai Traditional and Alternative Medicine Hospital. A total number of 80 participants, equally divided into three groups: two intervention groups of RD (n=26), YE (n=28), and a control group of stretching exercise (SE) (n=26) who completed the 4-week intervention program. The primary outcomes were pain relief assessed by Visual Analog Scale, Pressure Pain Threshold, muscle flexibility by Cervical Range of Motion. The secondary outcome was World Health Organization's Quality of Life test. ANOVA, paired t-tests and repeated ANOVA were used to analyze the data. The results showed that the comparison of all three groups before and after the exercises revealed a decrease in pain, better tolerance to pain and more flexibility of the neck muscles with statistical significance (p< 0.05). With respect to the quality of World Health Organization's Quality of Life, the comparison of all four domains in all three groups before and after the exercises indicated a statistically significant improvement in quality of life (p< 0.05). However, there were no differences in pain, neck muscle flexibility and quality of life between groups.

Arthroscopic Treatment of Scaphoid Nonunion With Olecranon Bone Graft and Screw Fixation Leads to Union and Improved Outcomes

PURPOSE

To evaluate the outcomes of arthroscopic treatment of scaphoid nonunion using olecranon bone graft and screw fixation and to analyze the outcomes in accordance with variations in the chronicity, location, and severity of nonunion.

METHODS

Between March 2012 and December 2020, patients with diagnoses of scaphoid delayed nonunion and nonunion with substantial bone resorption (Slade and Dodds grade IV-VI) underwent arthroscopic-assisted olecranon bone graft and screw fixation. Preoperative and postoperative measurements included the visual analog scale score for pain; range of motion; grip strength; the Modified Mayo Wrist Score; the Disabilities of the Arm, Shoulder and Hand (DASH) score; and the minimal clinically important difference for the DASH score. Union rate and duration were also evaluated. The outcomes between groups of patients with different conditions were analyzed.

RESULTS

Twenty-two patients were included. The average follow-up period was 32.5 months. The visual analog scale pain score, range of motion, grip strength, Modified Mayo Wrist Score, and DASH score were significantly improved after surgery (P < .001). The minimal clinically important difference threshold for the DASH score was reached by 100% of patients. At final follow-up, all patients had united scaphoid with no complications. The average time to union was 15.3 weeks. Group analysis showed significant improvements in mean grip strength between patients with delayed union (3-6 months) and those with chronic nonunion (> 1 year) (17.75 kg vs 12.25 kg, P = .032), between grade IV nonunion and grade V nonunion (14.86 kg vs 10.43 kg, P = .035), and between grade V nonunion and grade VI nonunion (10.43 kg vs 15.63 kg, P = .013). Patients with grade VI nonunion achieved union at 17.8 weeks postoperatively, a significantly longer period than that for patients with grade IV nonunion (11.4 weeks, P = .014).

CONCLUSIONS

Arthroscopic treatment of scaphoid nonunion using olecranon bone graft and screw fixation provided satisfactory outcomes regardless of the chronicity, location, and severity of nonunion.

LEVEL OF EVIDENCE

Level IV, therapeutic case series.

Efficacy of rtsa-byugs vs diclofenac gel in relieving knee pain of patients with osteoarthritis of the knee

Purpose

Rtsa-byugs, a massage oil from Bhutan, is a traditional herbal formula known for its anti-inflammatory properties and used in osteoarthritis treatment. This study investigates the efficacy of rtsa-byugs vs diclofenacgel in relieving knee pain in osteoarthritis patients.

Design/methodology/approach

A single-blind, randomized controlled trial was conducted amongst osteoarthritis knee patients at an orthopedic outpatient department of Thammasat University Hospital. Participants were randomly allocated to the rtsa-byugs (N = 31) or the Diclofenac gel (N = 31) group. Primary outcomes were assessed by the knee injury and osteoarthritis outcome scores (KOOS), visual analog scale (VAS) and goniometer at day 0, 1, 3, 7.

Findings

62 participants completed the study. The result of the KOOS scores demonstrated a significant improvement of symptoms at the end of the study in both treatment groups. Improvement of symptoms, pain, daily life living, sport and recreational score and quality of life assessment showed a significant difference from baseline (p < 0.001) within both groups. The quality of life score for the rtsa-byugs group increased significantly on day 3 and 7. The VAS score in both groups decreased with a significant difference from baseline to day 7. The mean value of extension of angle measurement was decreased in day 7, and the mean of flexion score increased in both groups when compared with the baseline.

Research limitations/implications

The duration of the study was very limited and included a small sample consisting of men and women.

Originality/value

Rtsa-byugs is safe and effective in relieving pain from osteoarthritis of the knee and can be used as an alternative treatment for knee osteoarthritis.

Hand Surgery in Thailand

Modern hand surgery in Thailand started after the end of World War II. It is divided into 4 phases. In the initial phase (1950-1965), the surgery of the hand was mainly performed by general surgeons. In 1965-1975, which was the second phase, many plastic surgeons and orthopaedic surgeons graduated from foreign countries and came back to Thailand. They played a vital role in the treatment of the surgery of the hand and set up hand units in many centers. They also contributed to the establishment of the "Thai Society for Surgery of the Hand," which still continues to operate. In the third phase (1975-2000), there was a dramatic development of microsurgery because of the rapid economic expansion. There were many replantation, free tissue transfers, and brachial plexus surgeries in traffic and factory-related accidents. The first hand-fellow training program began in 1993. In the fourth phase (since 2000), the number of hand injuries from factory-related accidents began declining. But the injury from traffic accidents had been increasing both in severity and number. Moreover, the diseases of hand that relate to aging and degeneration had been on the rise. Thai hand surgeons have been using several state-of-the-art technologies such as arthroscopic and endoscopic surgery. They are continuing to invent innovations, generating international publications, and frequently being invited as speakers in foreign countries.

Wide-awake local anesthesia for clavicle fracture fixation: A case report

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Clavicular fracture was treated with plate osteosynthesis using the WALANT technique.

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Adequate pain control and minimal bleeding were observed during the surgery.

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WALANT technique can be used in cases with unsuitability of general anesthesia.

Introduction

The wide-awake local anesthesia no tourniquet (WALANT) technique has been used in many orthopedic surgeries. The benefits of this technique are the avoidance of the adverse effects of general anesthesia (GA) and the overall reduction of the cost of surgery. However, a literature search revealed no published report on performing the WALANT technique for clavicular fracture surgery.

Presentation of case

We report a case of mid-shaft clavicular fracture that was treated with plate osteosynthesis using the WALANT technique in a patient with uncontrolled atrial fibrillation. During the operation, the patient did not experience any pain, and the procedure could be performed easily due to minimal bleeding in the operative field. The operation was completed successfully without any complications, and the patient was discharged from the hospital the day after surgery. Follow-up radiographs after three months showed union of the clavicle at the fracture site, and the patient could use his arm normally.

Discussion

Clavicular fracture is routinely treated with plate osteosynthesis under general anesthesia. In some patients with high morbidity and other risk factors for whom GA is unsuitable, the WALANT technique can prove to be an effective alternative.

Conclusion

Clavicular fixation can be performed successfully and without any complication under WALANT technique.

Case Report of Customized Distal Radius Prosthesis Replacement: An Alternative Treatment for Post-traumatic Unreconstructable Intraarticular Distal Radius Malunion

Severely comminuted intraarticular distal radius malunion can significantly affect a patient's quality of life. To date, there is no ideal solution. We propose customized distal radius prosthesis replacement as a treatment option. A 33-year-old policeman presented with left wrist deformity and loss of motion for five months following a distal radius fracture AO (Arbeitsgemeinschaft für Osteosynthesefragen) type-C3 which had been fixed with a volar locking plate incorporate with external fixation and Kirschner wire (K-wire) augmentation for two months. He needed to rely on wrist motion for work. Therefore, we fabricated a customized distal radius prosthesis based on his contralateral normal anatomy to replace the malunion site. The patient was satisfied and able to return to work two months after the operation. Thirty months later, the range of motion had improved from fixed 40° flexion and fixed 70° pronation deformity to 73° flexion, 79° extension, 75° supination, and 85° pronation. His DASH (Disabilities of the Arm, Shoulder, and Hand) score had improved from 80 to 14.2. His pain score, as measured by the visual analog scale, improved from eight preoperatively to two. Unreconstructable intraarticular malunion of the distal radius is a challenging problem with no treatment consensus. Customized distal radius prosthesis may provide a successful treatment option. Future research should elucidate long-term outcomes.

Outcomes of Endoscopic Carpal Tunnel Release With Ring Finger Flexor Digitorum Superficialis Opponensplasty in Severe Carpal Tunnel Syndrome

PURPOSE

To evaluate the outcomes of endoscopic CTR with ring finger flexor digitorum superficialis (FDS) opponensplasty for the treatment of patients with severe carpal tunnel syndrome (CTS).

METHODS

We prospectively studied 52 patients who were graded as having severe CTS by physical examination and electrodiagnostic studies and who underwent endoscopic CTR-ring finger FDS opponensplasty. Preoperative and postoperative data were collected for active perpendicular thumb abduction; Kapandji score for thumb opposition; grip, key, and tip pinch strength; Medical Research Council score on sensory and motor recovery; Semmes-Weinstein monofilament testing; thenar muscle bulk recovery; and work status.

RESULTS

Follow-up was 17.5 months on average (range, 7-34 months). Thumb abduction improved significantly from 13.2° (±4.6°) before surgery to 61.7° (±6.4°) afterward. Mean thumb opposition (as measured by Kapandji score) improved significantly from grade 1.5 to 8.7. Tip pinch strength significantly improved from 38.9% to 72.9% of the contralateral side. Medical Research Council scores improved to S3+ and S4 in 85% of patients and to M4 and M5 in 96% of patients. Sensory threshold recovery to 3.61 and 4.31 monofilament occurred in 85% of patients. We observed thenar muscle bulk recovery in 51.9% of patients. Time to return to work was 5 weeks after surgery, on average. Two patients reported scar pain, 2 reported pillar pain, and we found ring finger proximal interphalangeal joint contracture in 3.

CONCLUSIONS

Endoscopic CTR with FDS opponensplasty provides satisfactory outcomes of improved thumb abduction and opposition, sensory and motor recovery, and early return to work in patients with severe CTS.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Prevalence of Osteoporosis in Patients with Distal Radius Fracture from Low-Energy Trauma

Introduction: Osteoporosis is a devastating problem leading to significant morbidity and mortality. Patients with osteoporosis usually present with fractures from low-energy trauma and falls, commonly of the distal radius, which may precede more severe fractures like fracture of the neck of femur, but data from Thailand are limited. The objective of our study was to determine the prevalence of osteoporosis in patients with distal radius fracture from low-energy trauma. Materials and Methods: This was a descriptive retrospective study, performed at Thammasat University Hospital in Thailand, from January 2011 to June 2017. Patients aged more than 50 years with distal radial fractures from low-energy trauma with available bone mineral density (BMD) result were included. Patients with known secondary causes of osteoporosis were excluded. Patients were grouped by age, sex, and BMD status (normal, osteopenic and osteoporotic). Results: One hundred out of 351 patients with distal radial fractures had bone mineral density data but only 79 (73 females) met the inclusion criteria. Most patients were aged 60-69 years old (n=31, 42.5%). 47 (59.5%) patients were osteoporotic, 23 (29.1%) osteopenic, and 9 (11.4%) were normal. Seven (6 osteoporotic) patients suffered a more severe fracture subsequently. No deaths were recorded. Conclusion: Our study found a high rate of osteoporosis mostly in females, consistent with published literature. Assessing BMD is crucial in middle age and elderly patients with fractures to better manage osteoporosis and prevent more severe fractures in the future.

Effectiveness of hot herbal compress versus topical diclofenac in treating patients with myofascial pain syndrome

Myofascial pain syndrome (MPS) is a chronic pain disorder which causes musculoskeletal pain and inflammation in the body's soft tissues. Thai Traditional Medicine uses hot herbal compresses as analgesic and anti-inflammatory treatment. There are no scientifically validated follow-up studies after treatment using hot herbal compresses. Effects of hot herbal compresses as an alternative treatment for MPS in the upper trapezius muscle compared with the standard treatment (diclofenac) were examined. Sixty patients with myofascial pain syndrome in the upper trapezius muscle were randomly divided into two groups and assigned to receive either hot herbal compress or nonsteroidal anti-inflammatory drug (diclofenac) treatment for 2 weeks. Clinical assessments included visual analogue scale (VAS) for pain score, cervical range of motion (CROM) for the neck and pressure pain threshold (PPT) tolerability before and after treatment. Within the groups, all treatments caused significant improvement in VAS and marginally increased effectiveness in PPT; however, only hot herbal compress treatment improved CROM. Hot herbal compress was more effective than diclofenac in all tests. Results provided comparable clinical efficacy between hot herbal compress and diclofenac after 2 weeks of treatment. Hot herbal compress proved to be an effective complementary or alternative treatment for MPS in the upper trapezius muscle.

Distally Based Sartorius Flap to Cover Knee Joint Defect

INTRODUCTION

The coverage of soft-tissue defects around the knee joint has many reconstructive techniques depending on the size, location, and depth. We report a case with large soft-tissue defect at anterior knee joint that primary closure cannot be done with successfully used distally based sartorius flap and full-thickness skin graft to cover this defect.

CASE REPORT

A 30-year-old man had a large skin defect at the knee following a motorcycle accident. The patella tendon and patella were exposed. We use the sartorius muscle flap to cover the wound defect. First, a skin incision was done on the muscle alignment. Then, the sartorius muscle was dissected, and the proximal set of segmental vessels was identified and ligated. Afterward, the sartorius was moved into subcutaneous tunnel and expanded to provide coverage for the wound defect. Finally, we used the full-thickness skin graft to cover over the muscle flap. The flap and graft were survived. The patient could return to work after 1 month after the operation.

CONCLUSION

In the case with soft-tissue defects around knee joint, there are many operative techniques. Our case has a large wound at anterior aspect of knee joint. We used the distally based sartorius flap to cover the wound defect. Following the transposition, the sartorius remained viable through out its length, and the patient had full post-operativerecovery.

Metacarpal Locked Intramedullary Nail: Surgical Technique and Preliminary Outcome Report

In surgically indicated metacarpal fractures, the ideal fixation should provide an ample stability for early rehabilitation. Damage to surrounding tissue should be minimized as well, to prevent stiffness which determine the outcomes. We have created the metacarpal locked intramedullary nail (MCLN) that allows immediate motion even in unstable fractures. This preliminary report is objected to demonstrate the surgical technique and outcomes of novel metacarpal fixation. Three surgical indicated metacarpal fractures were treated by MCLN. Unlimited motion was started a day after surgery without external immobilization. Clinical and radiographic control were performed up to two years after the surgery. All of patients returned to previous level of daily activities within six weeks with minimal scar. All fractures were united. The total active motions were above 260° in every patient. Complications were not observed. With this encouraged clinical results, the MCLN could be the promising alternative surgical fixation for metacarpal shaft fractures.

A Comparative of Ginger Extract in Nanostructure Lipid Carrier (NLC) and 1% Diclofenac Gel for Treatment of Knee Osteoarthritis (OA)

Objective

To compare and evaluate the efficacy of ginger (Zingiber officinale Roscoe) extracts in NLC for treatment of osteoarthritis of knee compared to 1% diclofenac gel as an active control.

Material and Method

One hundred twenty patients age 50 to 75 years with OA knee, based on the American College of Rheumatology (ACR) criteria were randomized into two groups receiving ginger extracts in NLC and control 1% diclofenac gel for 12 weeks. The efficacy of treatment was monitored at 4, 8, and 12 weeks by using the WOMAC composite index and the Patient Global Assessment (PGA). The t-test was used to compare the mean scores at baseline in each group. Repeated ANOVA was used to compare the mean scores, and Chi-square test was used to compare the dichotomous variables between the two groups at 4, 8, and 12 weeks.

Results

One hundred eighteen participants completed the study and were included in the ITT efficacy analysis. Both ginger extract in NLC and diclofenac gel could significantly improve knee pain, stiffness, physical function, and PGA following 12 weeks of treatment. In the repeated ANOVA, there were no differences in the result between these two groups. The response rate for at least a 50% reduction in pain was significantly greater following Ginger extract in NLC treatment compared to topical diclofenac [40/59 (67.7%) vs. 27/59 (45.7%) p<0.05]. There were no significant adverse events.

Conclusion

Ginger extract in NLC relieves pain, improves function, and improves the Patient Global Assessment in OA knee during a 12-week treatment.

Improving of Knee Osteoarthritic Symptom by the Local Application of Ginger Extract Nanoparticles: A Preliminary Report with Short Term Follow-Up

OBJECTIVE

An evaluation ofthe efficacy and safety of Ginger (Zingiber officinale Roscoe) extract nanoparticlefor treatment of osteoarthritis (OA) of the knee.

MATERIAL AND METHOD

Sixty patients at the age range of 50 to 75 years old who were diagnosed with OA knee based on the American College of Rheumatology (ACR) diagnosis criteria were included in the present study. Participants received ginger extract in Nanostructure Lipid Carrier (NLC) rubbed three times a day for 12 weeks. Efficacy was assessed by Knee Injury and Osteoarthritis Outcome Score (KOOS), Index of Severityfor Osteoarthritis (ISOA), and patient's global assessment (PGA). A series of biochemical tests in serum and hematological parameters were established the safety of ginger extract in NLC. The paired t-test was used to compare the score before and after treatment. The comparisons of baseline and the 4-, 8-, and 12-week used repeated ANOVA.

RESULTS

Ginger .extract nanoparticles improved, with statistical significance, the patient's global assessment, knee joint pain, symptoms, daily activities, sports activities, and quality of life measured by KOOS, ISOA, andPGA, following 12 weeks of treatment (p<0.05). There were no safety issues, adverse events, or laboratory values.

CONCLUSION

Ginger extract nanoparticles relieves joint pain and improves problematic symptoms and improves the quality of life in osteoarthritis knees during a 12-week treatment.

The Metacarpal Locked Intramedullary Nail: Comparative Biomechanical Evaluation of New Implant Design for Metacarpal Fractures

BACKGROUND

The optimal fixation of metacarpal fracture should provide sufficient stability to permit early functionfor all types of fracture. However; it must preserve surrounding soft tissue during application and not require secondary removal due to its prominence. The prototype of metacarpal locked intramedullary nail (MCLN) was designed by our institute aiming to achieve those allfeatures.

OBJECTIVE

To biomechanically test our newly designed, locked metacarpal nail and compare with common current available fixation methods.

MATERIAL AND METHOD

Thirty chicken humeri were devided into 3 groups (n = 1 per group) according tofixation techniques: MCLN, 1.5 mm miniplate (Synthes), and Kirschner wire. After complete fixation, all specimens were osteotomized at mid-shaft creating transverse fractures. Five specimens from each group were tested by load of failure under axial compression, and another five under bending force.

RESULTS

In axial compression model, the loads tofailure in MCLN group was greatest (460 ± 17 N), which was significant higher than the Kirschner wire group. The MCLN group also showed the highest load to failure in bending test (341 ± 10 N). This value reaches statistical significance when compared with plate and Kirschner wire groups.

CONCLUSION

The MCLN construct provided higher stability than miniplate and Kirschner wire fixation both in axial and bending mode. Together with the minimally invasive and soft tissue-friendly design concept, this study suggests that MCLN is promising fixation option for metacarpal fracture.

Locked intramedullary nail: metacarpal geometry study in adults

BACKGROUND

Ideal fixation for metacarpal fracture should provide immediate stability to allow early rehabilitation. Locked intramedullary nail may fulfill the need. Metecarpal geometry has to be studied in order to design the locked intramedullaly nail.

OBJECTIVE

To study metacarpal geometry in adult cadaver for locked intramedullary nail design.

MATERIAL AND METHOD

Radiographs of metacarpals taken from 50 embalmed adult cadavers were measured for essential parameters for locked intramedullary nail design. Total length, proximal metaphyseal width, distal metaphyseal width, isthmus width and medullary canal width were measured. The parameters were analyzed by descriptive statistic.

RESULTS

The average total lengths were rangedfrom 44.53 to 65.42 mm. The average metaphyseal widths ofmetacarpal bone were between 11.42 to 16.42 mm. The average medullary canal widths were between 3.05 to 6.74 mm. The extreme small (less than 3 mm) medullary canals were found in index, middle, ring and small metacarpals.

CONCLUSION

The results of our study provide crucial preliminary data for locked metacarpal nail design for adult patient.

Acute closed traumatic sciatic nerve injury: a complication of heterotopic ossification and prominence of the femoral nail: a case report

The report of a 27-years-old man with presence of heterotopic ossification (HO) after femoral nailing 7years ago who developed foot drop afterfalling to the ground on his buttocks. Radiographs revealed a prominence ofthefemoral nail with HO in his right hip. EMG confirmedperoneal nerve injury ofthe hip region. Femoral nail and the HO were removed and external neurolysis was performed. At 9 months after surgery, he had not regain motor power thus posterior tibialis tendon transfer was performed to restore ankle dorsiflexion. Finally, at 2 years follow-up, he could ambulate well but did not regained sensation, extensor digitorum communis and peroneal muscle function.

The comparative study of reliability and reproducibility of distal radius' fracture classification among: AO frykman and Fernandez classification systems

OBJECTIVE

To study the reliability and reproducibility ofdistal radius fracture classification in plain radiographs.

MATERIAL AND METHOD

Ninety-eight displaced distal radius fractures radiographs were classified in four groups ofobservers. The first group consisted of one senior orthopedics staff and two hand-orthopedic surgeons (with experience ranging from ten to thirty years). The first group conducted and evaluated the research altogether This first group was also regarded as standard adjustment. The three other groups comprisedfourth year orthopedics residents, using AO, Frykman, and Fernandez classification systems with six weeks intervals. The results were processed with kappa statistics. The Research to be approached by Thammasat Ethic Committee.

RESULTS

The highest kappa coefficient in interobserver agreement was determined in Fernandez classification (0.415), AO classification (0.342), and Frykman classification (0.280). When intraobserver were evaluated, Fernandez classification had a highest mean kappa value (0.343). Then Frykman classification (0.310) and AO classification (0.292) followed. Likewise, the classification, of which each of senior orthopedics residents evaluated most resemble to standard adjustment, was Fernandez classification with a mean of 62.34%.

CONCLUSION

Fernandez classification provided satisfactory outcome comparing to standard adjustment and gave a highest inter and intraobserver agreement. Nevertheless, none of the classification systems examined in the present study has achieved an excellent outcome.

The efficacy of Plygersic gel for use in the treatment of osteoarthritis of the knee

OBJECTIVE

An evaluation of the efficacy of the combination of ginger (Zingiber officinale) and plai (Zingiber cassumunar) gel for the treatment of osteoarthritis of the knee using 1% diclofenac gel as a comparator.

MATERIAL AND METHOD

A double-blind, randomized, controlled trial of the combination of 4% ginger and plai extract in a gel (Plygersic gel) as compared with a 1% solution of diclofenac in patients with osteoarthritis knees. The number of participants in each group totaled fifty. The length of treatment was a 6 week period. The efficacy of the drugs was monitored by using the Knee Injury and Osteoarthritis Outcome Score (KOOS). The t-test was used to compare the scores before and after treatments in each group. The repeated ANOVA was used to compare the scores between the two groups.

RESULTS

Both Plygersic gel and diclofenac gel could significantly improve knee joint pain, symptoms, daily activities, sports activities and quality of life measured by KOOS following 6 weeks of treatment. In the repeated ANOVA, there were no differences in the results between the Plygersic and diclofenac gel groups.

CONCLUSION

Plygersic gel relieves joint pain and improves problematic symptoms and improves the quality of life in osteoarthritis knees during a 6 week treatment regimen with no differences to the 1% Diclofenac gel group.

The efficacy of Curcuma Longa L. extract as an adjuvant therapy in primary knee osteoarthritis: a randomized control trial

Nonsteroidal anti-inflammatory Drugs (NSAIDs) is one of the most commonly use medication for treatment of knee osteoarthritis which has the analgesic and anti-inflammation by inhibition of prostaglandin synthesis via COX-1 and COX-2 isoenzyme. The problem of prolong using NSAIDs has side effect on kidney, liver and GI system. Curcumin longa extract Curcumin) is the Asian herbal medicine that has the anti-inflammatory effect by down regulate activation of NF-kappaB and proinflammatory cytokines such as Tumor Necrotic Factor-alpha, Interleukin-1, Interleukin-8, and Nitric Oxide Syntase. Many research data had advocate for the combination therapy which can increase safety and efficacy with less side effect compare with monotherapy regimen especially when the medicine has the different mechanism of action. The present study is the double blind prospective randomized control trial to evaluate the efficacy of curcumin as an adjuvant therapy of diclofenac in primary knee osteoarthritis. 44 patients were randomized to take NSAIDs (diclofenac) 75 mg/d with placebo and the other 44 took NSAIDs (diclofenac) 75 mg/d with curcumin 1,000 mg/d for 3 months. The authors evaluated the Visual Analog Scale (VAS) for pain and Knee Injury and Osteoarthritis Outcome Score (KOOS) every month for 3 months. At the end of study 36 patients were completed for the first group and 37 for the study group. There was no difference in VAS [p-value = 0.923 (F = 0.009)]. The KOOS was analyzed in 5 categories symptom, pain, function in daily living, function in sport and recreation and knee related quality of life. The curcumin with diclofenac group had tendency to be better in Pain and Function in daily living, but there were no statistic different in all group [p-value = 0.412 (F = 0.683), p-value = 0.814 (F = 0.056), p-value = 0.446 (F = 0.589), p-value = 0.224 (F = 1.511) and p-value = 0.938 (F = 0.006)]. In conclusion, the adjuvant therapy ofcurcumin with diclofenac has the potential beneficial effect in comparison with diclofenac alone, but no statistical significance.

The efficacy of powdered ginger in osteoarthritis of the knee

Ginger is an effective treatment against nausea and vomiting but there are only a few clinical studies of the effect as an anti-inflammatory or analgesic agent. A double-blind randomized controlled trial of one gram of powdered ginger per day in a capsule compared with a placebo in patients with osteoarthritic knees was carried out. The number of participants in each group was thirty. The length of treatment was eight weeks. The efficacy of the drug was monitored by using the Knee Injury and Osteoarthritis Outcome Score (KOOS). The authors used repeated ANOVA to compare scores between each group. One gram ofpowdered ginger per day did not improve kneejoint pain, symptoms, daily activities, sports activities and quality of life compared with a placebo. Prominent side effects did not occur The systolic and diastolic blood pressure, body mass index and blood chemistry were not changed after receiving treatment. The present study showed that one gram per day of powdered ginger could not relieve joint pain and improve symptoms and the quality of life during eight weeks of-treatment of osteoarthritis of the knee compared with the placebo.

Clinical experience in forearm tourniquet use

OBJECTIVE

To assess the efficacy and complications of forearm tourniquet application in minor hand and wrist surgeries those use local anesthesia.

MATERIAL AND METHOD

A series of ninety-three patients underwent various kinds of hand and wrist surgery using forearm tourniquet performed by senior author (SN) at Thammasat University hospital in the last 5 years was collected. The tourniquet was applied at proximal forearm with 250 mm Hg pressure. The surgical tourniquet time tolerated by the patients, postoperative complications, and effectiveness for the surgeon to perform the surgery were collected and analyzed.

RESULTS

The forearm tourniquet provided bloodless field in all operations. All patients could tolerate forearm tourniquet up to 80 minutes (average 27 minutes). None of the patients had complications related to tourniquet uses after surgery.

CONCLUSION

Using forearm tourniquet in minor hand and wrist surgery is effective, helpful, and safe.

Closed traumatic rupture of both extensor tendons of the index finger in zone VI: a case report

The patient with closed traumatic rupture of both extensor tendons of the index finger in zone VI was described.

Level of undercarboxylated osteocalcin in hip fracture Thai female patients

The undercarboxylated osteocalcin (ucOC) level is increased in the elderly and postmenopausal women compared with the young, healthy, and reproductive women. The high level of serum UcOC reflects the vitamin K2 deficiency which not only results in high skeletal turnover, low bone quality, and low bone density, but also increases a risk of fracture. The objective of the study is to measure the ucOC level, the 25-hydroxy vitamin D (25(OH)D) levels, and the prevalence of vitamin K2 and vitamin D deficiency in Thai female patients with hip fracture. The serum UcOC and 25(OH)D levels of the 40 female patients with hip fracture (the mean age 77.2 +/- 9.7 years) were measured and compared to the control group of the 47 randomly selected female volunteers (the mean age 75.2 +/- 8.1 years) without osteoporosis-related problems. The serum level of UcOC (median) in the female patients with hip fracture was significantly higher than the control group (p = 0.0001). Fifty-three percent had the serum UcOC level above the cut-off point at 2.314 ng/ml and 83% had lower serum 25(OH)D than the cut-off point at 30 ng/ml. The serum UcOC levels; however, were not correlated with 25(OH)D levels (r = 0.191, p = 0.237). The high prevalence of vitamin K2 and vitamin D deficiency was found in the Thai female patients with hip fracture. The additional treatment with vitamin K2 supplement besides calcium and vitamin D is a beneficial effect for osteoporosis.

Dose effectiveness of transthecal digital block

PURPOSE

The optimal volume of local anesthetic for transthecal digital block has not yet been identified. The goal of this study was to understand the effect of different volumes of local anesthetic using a modified transthecal digital block.

METHODS

We performed a prospective, randomized, double-blinded, controlled study with normal volunteers. The subjects were randomly divided into 3 groups receiving 1, 2, or 3 mL of 1% lidocaine using a modified transthecal digital block. An investigator blinded to the assignment of subjects and dosages evaluated the onset, progression, and duration of anesthesia. Threshold sensory testing was performed every minute in the first 10-minute period and then at 15-minute intervals up to 85 minutes. Pain was assessed after infiltration using the visual analog scale.

RESULTS

A total of 45 blocks (15 subjects for each dosage) were performed. None of the volunteers who received 1-mL of block had adequate anesthesia. Mean onset of anesthesia with the 2-mL blocks was >6 minutes, whereas those of the 3-mL blocks took only 1.5 minutes. The mean progression and duration of anesthesia were quicker and longer, respectively, in the 3-mL blocks than the 2-mL ones. Pain associated with injection and discomfort after injection in the 2- and 3-mL blocks was not different, but was significantly higher than the 1-mL block.

CONCLUSIONS

The effectiveness of the 3-mL modified transthecal digital block is greater than the 1- and 2-mL blocks in terms of rapidity of onset, completeness, and duration of anesthesia.

Local injection of dexamethasone for the treatment of carpal tunnel syndrome in pregnancy

OBJECTIVE

To evaluate the results of 4 mg of dexamethasone acetate injections for the treatment of carpal tunnel syndrome in pregnancy.

MATERIAL AND METHOD

Twenty-four pregnant volunteers who suffered from carpal tunnel syndrome occurring in the third trimester of their pregnancies were injected with 4 mg of dexamethasone acetate combined with 1% lidocaine into the carpal tunnels. The volunteers filled the Boston symptom severity questionnaire and were examined by Phalen's test, Semmes-Weinstein monofilament test, grip strength, and pinch strength before injection, one month after injection, and one month after delivery.

RESULTS

There was significant improvement of symptoms, grip strength and pinch strength of the injected hand compared with the opposite side at one month after injection (p < 0.01). However, after delivery, the symptoms of carpal tunnel syndrome improved on both the injected and opposite hands.

CONCLUSION

Carpal tunnel syndrome in pregnancy is generally resolved after delivery and, therefore, should be treated conservatively. The patient with severe symptoms can be treated with dexamethasone injection in the third trimester with good results.

An estimation of grip strength during puberty

OBJECTIVE

Find the correlation of grip strength in puberty with chronological age, height, weight, and percentage of body fat.

MATERIAL AND METHOD

One thousand one hundred and five volunteer students between 11 and 14 years of age in Central Thailand participated in the study. The body weight and height were measured with standard balance and stadiometer The percentage of body fat was measured with Near Infrared interactance device. The grip strength was measured with Digital Handgrip Dynamometer The results were statistically analyzed by multiple linear regression.

RESULTS

It was found that grip strength has a significant correlation with age, height, and weight but not with percentage of body fat. The prediction of grip strength in puberty can be estimated with the following equations: a) For boys, Grip strength (kg) = -59.797 + 2.493 Age (yr) + 0.308 Height (cm) + 0.147 Weight (kg), and b) For girls, Grip strength (kg) = -32.887 + 0.926 Age (yr) + 0.236 Height (cm) + 0.155 Weight (kg).

CONCLUSION

The predictive value of an age, height, and weight equation is more precise than that of solely chronological age.

Comminuted Rolando's fractures: treatment with modified wrist external fixator and transmetacarpal pinning

BACKGROUND

For comminuted Rolando's fracture, external fixation with early mobilization is the treatment of choice however, there is controversy in this treatment. Low-profile or mini external fixator can be used, but expense and availability of this kind of implant in Thailand has resulted in using various techniques of surgery. The purpose of this retrospective study was to present the authors' alternative technique with modified implants and the outcome in the management of comminuted Rolando's fracture.

MATERIAL AND METHOD

The patients with comminuted Rolando's fracture were treated by using external fixation across the wrist (mostly by locally-made implants) between the radius and the first metacarpal and transmetacarpal K-wire fixation from the first to the second metacarpal.

RESULTS

Between 1999 and 2005, six patients with a mean age of 25 years (range, 19-33 years) were studied The average follow-up period was four months. Satisfactory reductions were achieved in all fractures. The average operation time was 27.5 minutes. All closed fractures united within six weeks and had satisfactory results, which was normal range of motion of thumbs and wrists and with no complications. Only one opened fracture caused by a gun shot injury was healed in eight weeks and had a mild degree of reflex sympathetic dystrophy.

CONCLUSION

Closed reduction and external fixation with modified wrist external fixator and transmetacarpal pinning is simple, safe, fast, and effective for the treatment of comminuted Rolando's fractures.