Adhesive capsulitis (AC) or frozen shoulder is an inflammatory condition characterized by joint stiffness and pain. Although its pathogenesis is not fully elucidated, inflammation (either acute or low-grade inflammation) is believed to play a crucial role. An increase in reactive oxygen and nitrogen species also occurs in AC. The management of AC is challenging for orthopedic surgeons and physical therapists. Intra-articular hyaluronate injection is a treatment option. Yet, failure is reported and may depend upon oxidative breakdown of hyaluronan. Adelmidrol is a palmitoylethanolamide analogue and azelaic acid derivative exerting antioxidant activity in a number of fibrotic disorders. Here we first report the in vitro ability of Adelmidrol to protect hyaluronan against oxidative degradation and to exert an antioxidant effect against hydrogen peroxide-induced increase in nitrite release and intracellular reactive oxygen species in the macrophage J774A.1 cell line. We then investigated a new intra-articular formulation of high molecular weight (1300-2000 kDa) hyaluronic acid (1%) and Adelmidrol (2%) in two AC patients partially responding to physical therapy. Within a tailored physical therapy approach, three fortnightly intra-articular injections of this formulation allowed for a progressive reduction in pain severity, as well as improved range of motion and daily living activities, with the good outcome being maintained at the six-month follow-up in both patients. Overall, the data show Adelmidrol's protective activity against hyaluronic acid oxidation and provide preliminary information for further studies to investigate the association of Adelmidrol and high molecular weight hyaluronic acid in the management of AC patients.
Introduction: Infected non-union of the tibial diaphysis is a refractory disease with high recurrence rates. It may be complicated by persistent local infection, bone and soft tissue loss and limb deformity. The masquelet technique is cost-effective in managing bone loss in the treatment of infected non-union. It does not require specialized training and sophisticated instruments. Case Report: A 16-year old female with recurrent discharging sinuses on the right leg following open reduction and internal fixation of a tibial shaft fracture. There were shortening, muscle atrophy, discharging sinuses on the anteromedial right leg and stiffness of the right ankle joint. Conclusion: Infected tibial shaft non-union may run a protracted course with reduced productivity and missed work. It may be refractory to multiple surgical procedures and result in limb deformity. Operative treatment of the disease with the masquelet technique could be safe, effective and applicable in a limited-resource setting. Additionally, the masquelet technique improves bone union and limb function. Staged surgical treatment, involving thorough debridement, maximises treatment success. The masquelet technique is a viable choice for the management of infected tibial shaft non-union and improves bone union and limb function. Tri-calcium phosphate augmentation of autograft in the treatment of large long bone defects increases graft volume and could promote bone union. Staged surgical treatment of infected tibial diaphyseal non-union maximises treatment success.
