This clinical case series revealed successful management of Salter-Harris Type 2 growth plate injury at distal radius with LLLT achieving bone healing and correction of mal-alignment without casting Materials & Methods: This represents a prospective clinical case series of 6 children all suffering Salter-Harris Type 2 injury after slip and fall injury. LLLT was administered on alternate days emitting from GaAIAs semi-conductor laser of 810 nm wavelength. Serial x-rays were checked, clinical followed up for 2 years to assess bone length Results: All 6 children had good bone healing and the angulated bony fragments were corrected without the need of open or close reduction. Long term 2 year follow up revealed pain-free upper extremity while the bone length was equal to the contralateral upper extremity Conclusion: LLLT if administered properly can be used as conservative treatment of Salter-Harris Type 2 injury in children
Objective: The current clinical case series assess the use of low-level laser therapy (LLLT) in non-operative care of 7 patients with tongue-type fractured calcaneum with significant comminution who refused surgery without the need of bone-grafting with the aim of early rehabilitation with early ambulation with protected weight bearing Materials and Methods: The patient cohort consisted of 7 consecutive unselected patients with tongue type calcaneum fracture all with significant degree of comminution. All the patients refused operation and prefer early fracture healing and ambulation with non-operative means. Results: All patients on serial X-ray as well as CT scan checking not only had solid union of the significantly comminuted fracture, but all had good re-modelling of the buckling and increased width of the calcaneum bone. The calculated p value is statistically significant at p < 0.01 Conclusion: LLLT not only enhances fracture healing, it also has the power to help to re-model comminuted fractured calcaneum to spare the patient of operative intervention and at the same time allow early weight-bearing at a mean of 8 weeks, and help prevent unsightly widening of the os calcis bone.
Armed non-union is a rare complication due to cortical intrusion of an intramedullary nail. The management of this type of complication is difficult because combining both a problem of consolidation and axial deformation by retraction of the soft tissue parts. Our report is about an observation of an armed non-union by cortical intrusion of distal end of the nail.
Objective: The current clinical case series assess the use of low-level laser therapy (LLLT) in correcting residual fracture angulation of distal radius pediatric fractures that occur despite casting Materials and Methods: The patient cohort consisted of 21 consecutive unselected patients with pediatric distal radius fracture all with various degrees of angulation despite initial close-reduction and casting done in government hospitals. All the parents of the patients refused operations and refused further manipulation of the painful wrist of their child. All subjects were given soft wrist braces, together with low-level laser therapy (LLLT) on alternate days for 8 consecutive weeks. Results: All patients on serial X-ray checking not only had solid union of the incompletely consolidated fracture, but all had total or near total correction of their fracture angulation despite no manipulation performed. The calculated p value is statistically significant at p < 0.01 Conclusion: LLLT not only enhance fracture healing, it has the power to help correct fracture angulation to better re-model the partially healed and angulated pediatric fractures.
Objectives: Virtual reality simulators for open orthopaedic procedures, such as total knee replacement (TKR), are uncommon compared to arthroscopic or fluoroscopic procedures. The Ossim Sim-K is to our knowledge the first virtual reality TKR simulator with haptic feedback and we sought to investigate the face and content validity of the first iteration of this device. Methods: Thirty members of the local orthopaedic department were recruited for this study. After completing a full simulation, each candidate completed a questionnaire utilising a 7-point Likert scale throughout, to assess face and content validity. Candidates were deemed either inexperienced or experienced based on whether they had performed less or more than 40 TKR respectively. Results: Questionnaire results were positive for all items related to both face and content validity, though inexperienced surgeons were more positive about the Sim-K in 7 of the 10 face validity items and 2 of the 5 content validity items. Conclusions: The Sim-K was well received, particularly by inexperienced surgeons with respect to both face and content validity. The Sim-K represents a promising start in the production of a TKR simulator with haptic feedback. With further development this system has the potential to be valuable in the training of orthopaedic surgeons.
Background : The ability to mobilize without assistance is integral to maintaining independence. Patients treated with tibio-talo-calcaneal arthrodesis are often kept non-weightbearing post-operatively. Our hypothesis is that a dynamically locked hindfoot arthrodesis nail and immediate weight-bearing does not compromise union rates or time to union. Methods : All patients who underwent hindfoot fusion nails from 2009-2017 treated with 2 different intramedullary nails (23 static in 20 patients vs 11 dynamic locking in 11 patients) were retrospectively reviewed. Post-operative radiographs were analyzed for union and time to union, and post-operative notes were reviewed for complications and revision surgery. Results : 11 patients with a dynamically locked hindfoot nail were allowed to commence full weight-bearing from day 1 post-operatively, whereas 20 patients (23 nails) were treated with a statically locked nail and kept non-weightbearing for 12 weeks. Indications for surgery were grouped into: arthritis, inability to maintain fracture position, and neuro-muscular pathology. 90% of patients in the early weightbearing group progressed uneventfully to union and did not require any further surgery, compared with 83% in the non-weightbearing group. Conclusion : Primary ankle and subtalar arthritis has a significant impact on weight-bearing. We believe that the use of a dynamically locked hindfoot arthrodesis nail allows immediate and simple mobilization post-operatively in a patient population who is unable to sustain non-weightbearing. This minimizes complications, does not compromise the end goal of union, and potentially reduces hospital stay.
Proximal tibiofibular joint instability is a relatively rare diagnosis and there is a lack of consensus regarding its best surgical treatment. The current case report documents the presentation and successful surgical treatment of proximal tibiofibular joint instability in two patients using dynamic fixation with two TightRopes in diverging fashion and bioabsorbable screw fixation. The described surgical procedure can be performed with basic surgical instruments at relatively low cost and minimal risk to the patient.
Objective: This represents a prospective clinical case series to assess the efficacy of low-level laser therapy (LLLT) in treating delayed union of hip sub-trochanteric fracture after intra-medullary nailing Materials and Methods: the study period of the clinical case series lasted from 2014 to 2018. Serial unselected patients with delayed union of hip sub-trochanteric fractures who consented for a course of non invasive LLLT administered on alternate days for a period of 12 weeks with a view to improve bony healing entered the study. Radiographs were taken at intervals of 4 weeks to assess for evidence of radiological bone healing. Only non-pathological sub-trochanteric fractures were included as underlying malignancy contraindicates the use of laser. Results: among the study population of 13 subjects, there was only one subject whose delayed union failed to respond positively to 12 weeks of LLLT treatment. All remaining 12 subjects went on to solid radiological union (p value less than 0.5) Conclusion: Use of 12 weeks of non invasive LLLT treatment is clinically effective in managing delayed union of hip subtrochanteric fractures without resort to revision surgery and/or bone grafting.
This paper reports on the medium-term mean 2-year prospective follow-up of a patient cohort of 50 unselected patients with mean age of 55 years who visited our tertiary referral pain center for painful sciatica refractory to not less than 8 weeks of conventional physical therapy with a view for treatment with low-level laser therapy (LLLT) as a possible alternative to operative intervention. Materials and methods: All patients in this prospective cohort study had documentation of the diagnosis by magnetic resonance imaging documenting one level inter-vertebral disc prolapse before study entry and all had failed to respond to a combination of conventional physical therapy and nonsteroidal anti-inflammatory medications for not fewer than 8 weeks. LLLT, at a wavelength of 810 nm emitted from a GaAIAs semiconductor laser device with 5.4 J per point and a power density of 20 mW/cm2, was employed to irradiate not only the relevant acupuncture points, but also via the use of scanning mode for the whole affected dermatome. The treatment regimen consisted of three sessions of treatment per week for 12 consecutive weeks. Each treatment session lasted 540 seconds, with 180 seconds for irradiation of the axial skeleton and 180 seconds for the affected dermatome. An additional 180 seconds will be used to irradiate the relevant acupuncture points. Serial clinical assessment was undertaken using the Visual Analogue Score (VAS) for pain. Treatment failure being defined as break-through pain which necessitated operative intervention or the need for surgery within 2 years. Results: A total of 50 sciatica patients with one level disc prolapse with nerve root impingement were treated, with 2.2 years mean follow up. With the exception of one patient who defaulted after one week of therapy, all subjects showed significant improvement in VAS pain score at the end of 12-weeks’ LLLT treatment and, surprisingly, the improvement was found maintained at follow-up assessments at 1-year mark and 2-year mark. None of the subjects required operative intervention at the 2-year mark. The results achieved statistical significance as the null hypothesis was rejected.
Introduction: Prosthetic joint infections (PJI) occur in about 2% of knee arthroplasties (TKA), resulting in significant morbidity, mortality
Objective: The current clinical case series assesses the early clinical outcome of the use of low-level laser in the treatment of delayed union of upper and lower extremity fractures. Materials and Methods: The patient cohort consisted of 17 consecutive unselected patients with delayed union. All patients refused operations. All subjects were given functional Sarmiento brace, together with low-level laser therapy (LLLT) on alternate days for 8weeks in upper limb fracture cases, and 12 weeks in lower limb fracture cases. Results: All patients had solid union, mean time for union for upper and lower limb fractures were 7 and 10 weeks respectively. The two non-responders include one patient who refused to come for follow up treatment and another who was non-compliant with splint wear The calculated p value was statistically significant at p < 0.05. Conclusion: LLLT markedly shortens the healing time and can be used in treating upper and lower limbs fractures with delayed union.
